Cardiovascular Risk Reduction in Metabolic Dysfunction-Associated Steatotic Liver Disease and Metabolic Dysfunction-Associated Steatohepatitis

Abstract

Purpose of review: Metabolic dysfunction-associated steatotic liver disease (MASLD) is the most common chronic liver disease, characterized by hepatic steatosis with at least one cardiometabolic risk factor. Patients with MASLD are at increased risk for the occurrence of cardiovascular events. Within this review article, we aimed to provide an update on the pathophysiology of MASLD, its interplay with cardiovascular disease, and current treatment strategies.

Recent findings: Given their high burden of cardiovascular comorbidities, patients with MASLD or MASH should undergo regular cardiovascular risk assessment using established risk models. In the absence of liver-specific therapies, therapeutic strategies should focus on improving cardiometabolic risk factors. Patients require a multimodal and multi-stakeholder treatment approach, including optimization of lifestyle, dysglycemia, obesity, and dyslipidemia. Statin treatment represents a safe and effective but often underused therapy in the management of at-risk patients with MASLD and MASH. Novel promising approaches include the use of GLP-1 receptor agonists, especially in, but not limited to, patients with cardiovascular disease and obesity. Patients with MASLD and MASH are at high cardiovascular risk requiring a multi-modal therapeutic approach including regular cardiovascular risk assessment, as well as lifestyle and pharmacological interventions. Statin therapy represents an inexpensive, safe and effective therapy across the spectrum of non-alcohol related steatotic liver diseases without major safety concerns. More prospective, randomized trials in patients with MASLD and MASH are needed.

Keywords: Diabetes; Hypertension; MASH; MASLD; Metabolic dysfunction-associated steatohepatitis; Metabolic dysfunction-associated steatotic liver disease; Metabolic syndrome; Obesity; Statin.

Fig. 1

Diagnostic and therapeutic approach to patients with MASLD and MASH. Given their high burden of cardiovascular comorbidities, patients with MASLD and MASH should undergo regular cardiovascular risk stratification. Central to a multimodal treatment approach is lifestyle modification, including exercise, diet optimization, and weight loss. Depending on the estimated cardiovascular risk, initiation on specific therapies for the treatment of dyslipidemia, obesity, and dysglycemia is indicated. Key: MASLD: metabolic dysfunction-associated liver disease; MASH: metabolic dysfunction-associated steatohepatitis; CVD: cardiovascular disease; ASCVD: atherosclerotic cardiovascular disease; HbA1c: haemoglobin A1C, AHA: American Heart Association; ACC: American College of Cardiology; ESC: European Society of Cardiology; GLP-1: glucagon-like peptide-1; SGLT2: sodium-glucose cotransporter 2; PPAR: peroxisome proliferator–activated receptor; LDL-C: low-density lipoprotein cholesterol