Patients with a steatotic liver disease associated with metabolic dysfunction (MASLD) or steatohepatitis associated with metabolic dysfunction (Mash) has an increased risk of cardiovascular complications. A recent review published in Current cardiology reports Added to this set of literature, highlighting the value of pharmacological interventions and lifestyle in this population of patients, as well as the importance of undergoing more regular cardiovascular risks.1
Steatohepatitis patients associated with metabolic dysfunction include increased risks for cardiovascular disease and related events | Image credit: Reyanking999 – Stock.adobe.com
To receive a diagnosis for masld, patients need at least 1 other cardiometabolic risk factor, such as high blood pressure, diabetes or obesity. The “pro -athotic environment” generated in MASLD / MASH – including systemic inflammation, endothelial dysfunction and oxidative stress – also closely overlapping the pathophysiology of cardiovascular disease (CVD), the authors wrote. Not only do Masld patients have a greater incidence of MCV (gold: 1.64; 95%CI, 1.26-2,13),2 But some more recent analyzes suggest that Masld is an independent MCV risk factor.3
Despite these results, the authors noted how clinical guidelines remain in the running as 2021 ESC guidelines on cardiovascular disease in clinical practice Maintain that traditional risk factors increase the risks of MCV, not masld.1
In the midst of contradictory opinions, the authors continued, various directives of the European Society of Cardiology (ESC), the European Association for the study of the liver, the American Heart Association and the American Association for the Study of Liver Disease are all agreeing on the value of frequent assessments of cardiovascular risks. Clinical interventions are mainly focused on the management of cardiovascular risk factors, as variations in glucose and lipid metabolism are supposed to cause these risks.
“The effects of food, increased exercise and subsequent weight loss have not only a positive impact on cardiovascular health, but also improve various parameters and risk factors associated with Masld and Mash,” wrote the authors, specifically pointing to the emerging value of low calorie diets. Consequently, by working to prevent the development of diabetes, the occurrence of MCV events, the progression of liver cirrhosis, as well as to improve long -term survival results and quality of life, were the main treatment objectives.
It is recommended to be physically active for about 150 minutes per week, which is informed by research suggesting that exercise can have a positive influence on the prevention and resolution of liver diseases.4
“It has also been shown that sufficient weight loss has a positive impact on the markers of liver damage and other MASLD biomarkers, with more pronounced changes observed in individuals with greater reduction,” added the authors.1
The treatment of statins remains the recommended first -line treatment, the intensity of the processing in correlation with the risk of individual MCV and the degree of liver damage. However, statin interventions are underused in the event of a MASLD accompanied by dyslipidemia – with numerous analyzes indicating that almost 50% of patients are left out of statins despite clinical guidelines and recommendations. High levels of transaminases, advanced diseases and awareness of the missing supplier with regard to steatosis has proven to be the main predictors of this under-utilization.5
“High transaminases in the context of Masld or Mash, however, are most often linked to the liver disease itself, which is caused and fueled by cardiometabolic risk factors which are targeted by the treatment of statins, thus representing a therapeutic dilemma in clinical practice”, wrote the authors, indicating that light elevations should not The continuation of statin therapy or the abolition of the first places.1
While the authors concluded their review, they refer to the whole literature suggesting the potential advantages of alternative interventions, such as bariatric surgery, receptor inhibitors activated by the proliferator of peroxystomas, the inhibitors of the Bushing-2 of the Glucagon 1 (Glucose Glucose Contransporter-2, Patients with patients with patients with patients with patients with patients with patients with patients with patients with patients for patients for patients with patients with patients with patients for patients for patients for patients with patients with patients with patients for patients for patients with patients with patients with patients with patients with patients with patients Patients with patients for patients for patients for patients with patients for patients with patients for patients with patients with patients with patients. Previous research has established the positive impact and specific to the lipids of GLP-1 receptors agonists; As these therapies become more integrated into the hepatological treatment landscape, larger and phase 3 study data remain “impatiently awaited”.1
References
1. Bernhard J, Galli L, Speidl WS, Krychtiuk Ka. Reduction of cardiovascular risk of steatotic liver disease associated with metabolic dysfunction and steatohepatitis associated with metabolic dysfunction. CURR CARDIOL REP. 2025; 27 (1): 28. DOI: 10.1007 / S11886-024-02185-5
2. Targher G, Byrne CD, Lonardo A, Zoppini G, Barbi C. Non-alcoholic hepatic disease and risk of incident cardiovascular disease: a meta-analysis. J Hepatol. 2016; 65 (3): 589-600. DOI: 10.1016 / J.JHEP. 2016.05.013
3. Duell PB, Welty FK, Miller M, et al. Non -alcoholic liver disease and cardiovascular risk: a scientific declaration by the American Heart Association. Arterioscler Thromb Vascin Biol. June 2022; 42 (6): E168-E185. DOI: 10.1161 / ATV.0000000000000153
4. Sung KC, Ryu S, Lee Jy, Kim Jy, Wild Sh, Byrne CD. Effect of exercise on the development of the new foie gras and the resolution of existing foie gras. J Hepatol. 2016; 65 (4): 791-797. DOI: 10.1016 / J. JHEP. 2016.05.026
5. Blais P, Lin M, Kramer JR, El-Serag HB, Kanwal F. Statins are underused in patients with non-alcoholic liver disease and dyslipidemia. Dir di sci. 2016; 61 (6): 1714-20. DOI: 10.1007 / S10620-015-4000-6