Metabolic dysfunction-associated steatotic liver disease and cardiovascular risk: a comprehensive review

Abstract

Metabolic dysfunction-associated steatotic liver disease (MASLD), previously termed nonalcoholic fatty liver disease (NAFLD), poses a significant global health challenge due to its increasing prevalence and strong association with cardiovascular disease (CVD). This comprehensive review summarizes the current knowledge on the MASLD-CVD relationship, compares analysis of how different terminologies for fatty liver disease affect cardiovascular (CV) risk assessment using different diagnostic criteria, explores the pathophysiological mechanisms connecting MASLD to CVD, the influence of MASLD on traditional CV risk factors, the role of noninvasive imaging techniques and biomarkers in the assessment of CV risk in patients with MASLD, and the implications for clinical management and prevention strategies. By incorporating current research and clinical guidelines, this review provides a comprehensive overview of the complex interplay between MASLD and cardiovascular health.

Keywords: Cardiovascular risk; Metabolic dysfunction-associated steatotic liver disease; Metabolic-associated fatty liver disease; Nonalcoholic fatty liver disease.

Fig. 1

Pathophysiological mechanisms linking MASLD to CVD (Created with BioRender.com). IR: insulin resistance, MASLD: metabolic dysfunction-associated steatotic liver disease, CVD: cardiovascular disease

Fig. 2

Effect of MASLD on traditional cardiovascular risk factors (Created with BioRender.com). MASLD: metabolic dysfunction-associated steatotic liver disease

Fig. 3

MASLD and its multifaceted CVD complications (Created with BioRender.com). MASLD: metabolic dysfunction-associated steatotic liver disease, CVD: cardiovascular disease

Fig. 4

Potential preventive and therapeutic strategies for CVD risk in MASLD (Created with BioRender.com). MASLD: metabolic dysfunction-associated steatotic liver disease, CVD: cardiovascular disease, DM: diabetes mellitus, GLP-1: glucagon-like Peptide 1, SGLT-2: sodium glucose-linked transporter 2, ACEI: angiotensin-converting enzyme inhibitor, ARB: angiotensin receptor blocker, MASH: metabolic dysfunction-associated steatohepatitis, TZDs: thiazolidinediones