Today, cardiovascular disease is the primary cause of death in people living with non-alcoholic fatty liver disease (NAFLD), a liver-scarring condition that is commonly linked to both obesity and type 2 diabetes. New research also shows that NAFLD may be independently linked to atherosclerosis, a hardening of the arteries, which researchers say may help explain why the liver disease carries such a high cardiovascular risk, ScienceDaily reports.

The findings, recently published in the journal Hepatology, studied nearly 6,000 people referred to a heart clinic in Pitié-Salpêtrière Hospital in Paris between 1995 and 2012 who were diagnosed with NAFLD. All were examined using a carotid ultrasound, which measured the thickness of plaque in their arteries, as well as the fatty liver index (FLI), a biomarker panel commonly used to diagnose the condition. They found that high FLI scores were associated with higher incidences of pre-atherosclerotic lesions, which often predict cardiovascular events.

In fact, researchers said fatty liver disease was a far better predictor of heart disease risk factors than diabetes or high cholesterol, which have commonly been thought to be the main drivers of cardiovascular issues in people with NAFLD. The study also showed that people with fatty livers who were not overweight and did not have type 2 diabetes or high blood pressure also had a higher risk of developing heart complications.

Researchers involved with the study recommended strict monitoring of heart health and metabolic complications in people living with NAFLD moving forward, even if they have no other cardiovascular risk factors.