Connecting the Dots: Hepatic Steatosis as a Central Player in the Choreography of the Liver-Cardiovascular-Kidney-Metabolic Syndrome

Abstract

Metabolic dysfunction-associated steatotic liver disease (MASLD) is the most common chronic liver disease worldwide, with a reach extending beyond the liver to include other metabolic syndrome-related disorders. Cardiovascular disease and type 2 diabetes mellitus are recognised non-communicable disorders and often downstream complications of MASLD and share similar risk factors. However, MASLD has not been afforded parity alongside other cardiometabolic non-communicable disorders, including the cardiovascular-kidney-metabolic (CKM) syndrome. Notably, MASLD is an independent risk factor for increased all-cause mortality and cardiovascular disease. This review aims to position MASLD as a central player in lipid metabolism, systemic inflammation, and insulin resistance, which are key features in the pathogenesis of the CKM syndrome. MASLD is an integral player enjoining the liver to the CKM syndrome as the liver-CKM syndrome. Increasing interdisciplinary awareness of this will enhance patient care.

Keywords: Adiposity; Atherosclerosis; CKM; CVD; Cardiovascular disease; Fatty liver; Hepatic steatosis; Inflammation; MASLD; Metabolic dysfunction–associated steatotic liver disease; T2DM; Type 2 diabetes mellitus.