Add fatty liver disease to the list of major risk factors that result in heart attack and stroke, a new study says.

Most people with non-alcoholic fatty liver disease die from cardiovascular disease, but this is no coincidence because the ailment also damages the body’s blood vessels, researchers find.

Nonalcoholic fatty liver disease (NAFLD) is a term used to describe the accumulation of fat in the liver of people who drink little or no alcohol. Found primarily in adults and children who are overweight, it is rising in epidemic numbers, experts say.

Traditionally, NAFLD is considered associated with cardiovascular disease, much like other risk factors such as obesity, diabetes and abnormal cholesterol, but French researchers decided to look at whether it is actually an independent cause of the condition.

They analyzed nearly 6,000 cardiovascular disease patients referred to a Paris hospital between 1995 and 2012 to determine whether NAFLD was an incidental or an independent cause of atherosclerosis of the carotid arteries, the major blood vessels in the neck that supply blood to the brain, neck, and face. Atherosclerosis is the artery-narrowing disease that causes cardiovascular disease.

They found that NAFLD was independently associated with the pre-atherosclerotic lesions used to predict cardiovascular events such as heart disease and stroke.  In fact, it was a better predictor of these events than either diabetes or abnormal cholesterol levels, they added.

Further more, long-term follow-up in 1,872 patients after eight years added a further critical piece of information by confirming that patients with fatty liver were more likely to develop carotid plaque over time.

The study also found that that those patients were at an increased risk even if they were not overweight or had diabetes, the researchers say.

Patients with NAFLD should be monitored for cardiovascular disease and doctors should take this into consideration for treatment with statins, for example, the researchers said of their study, which appears in the Journal of Hepatology.