Non-alcoholic fatty liver disease (NAFLD) and non-alcoholic steatohepatitis (NASH) as
progressive form of the disease are associated with cardiovascular risk factors including obesity,
dyslipidaemia, hyperglycaemia and hypertension. When NAFLD is associated with cardiovascular disease,
mortality of NAFLD patients is increased due to cardiovascular disease. Prevalence of NAFLD
and NASH is high, but it seems that epidemic of the disease is under-recognized and under-appreciated.
Linking pathophysiological mechanisms are complex and still not well understood. The main related
pathophysiological mechanisms are lipid factors, insulin resistance, inflammation, proinflammatory
cytokines, oxidative stress, pro-coagulant status, hyperglycaemia and adipokines. First-line management
focuses on lifestyle modifications in both diseases. Several therapeutic interventions, insulin sensitizer
agents, lipid lowering drugs, antioxidants, such as vitamin E, have been proposed. Statins appear to be
safe, but their use in the treatment of NAFLD and NASH is under-appreciated. Many different agents
are being investigated as future drugs for the treatment of this clinical entity. The aim of the review is to
examine the extent of the epidemic and the mediating mechanisms, to critically evaluate current guideline
recommendations, and to consider current and future medications for this disease.