Guideline-directed medical strategies for the co-management of heart failure and metabolic dysfunction-associated steatotic liver disease

Abstract

There is a high and rising global prevalence of people with both metabolic dysfunction-associated steatotic liver disease (MASLD) and heart failure, which has a severe impact, highlighting the need to address these conditions. However, the relationship between MASLD and heart failure remains underexplored. This comprehensive narrative review explores the shared pathophysiological mechanisms, diagnostic evaluations, and current medical and surgical recommendations for heart failure therapy in the context of co-existing MASLD. Here, we show the need for co-management of MASLD and the different subtypes of heart failure, integrating both standard and innovative heart failure treatments with those targeting MASLD. We highlight the benefits of certain drug classes and surgical interventions for both conditions while noting potential adverse outcomes with others. To address the global rise in metabolic diseases, a holistic, coordinated, and multidisciplinary approach is essential. Collaborative efforts between cardiologists and hepatologists are crucial for developing tailored interventional strategies to prevent and manage comorbid conditions, thereby mitigating the threats posed by MASLD and heart failure.

Fig. 1. The inflammatory cascade and subsequent insulin resistance, adipocyte dysfunction, lipotoxicity, and pro-inflammatory milieu caused by MetS, and therefore heart failure and MASLD, produce bidirectional downstream multisystem adverse effects.

Specifically, fatty deposits in the liver and heart heart failure potentiate inflammation, causing further damage, including fibrosis, atherosclerosis, prothrombotic states, etc. MASLD metabolic-dysfunction associated steatotic liver disease, MetS metabolic syndrome.