Metabolic dysfunction-associated steatotic liver disease, cardiometabolic risk factors, and cardiovascular disease

BACKGROUND AND AIMS: Metabolic dysfunction-associated steatotic liver disease (MASLD) affects over one third of adults worldwide and represents a growing public health challenge. In addition to becoming the leading cause of end-stage liver disease and liver transplantation in the United States, MASLD is currently a major risk factor for metabolic and cardiovascular disease. The diagnosis of MASLD is defined by the presence of a fatty liver in combination with one or more of five cardiometabolic risk factors, excluding excessive alcohol consumption. While the individual risk factors are all observationally associated with a fatty liver, the connection between these cardiometabolic risk factors and fatty liver has not been fully explained. METHODS: In this review we describe how fatty liver is associated with each of the cardiometabolic criteria of the MASLD diagnosis. We review the pathophysiological mechanisms between the cardiometabolic risk factors contributing to the MASLD diagnosis and development of fatty liver. We describe how MASLD associates with cardiovascular disease and suggest that fatty liver is associated with cardiovascular disease through very low-density lipoproteins. Finally, we describe current guidelines and ongoing pharmaceutical approaches in the treatment of MASLD with the focus on cardiovascular risk factors. RESULTS: This review provides a comprehensive overview of MASLD. Its association with common risk factors, including the mechanisms leading to cardiovascular disease, and finally an overview of the advised clinical approach according to current guidelines. CONCLUSION: This review encompasses clinical aspects of MASLD from risk factors to outcome, including recommended clinical handling of these patients.