Abstract
There is a new awareness of the widespread nature of metabolic dysfunction–associated steatotic liver disease
(MASLD) and its connection to cardiovascular disease (CVD). This has catalyzed collaboration between cardiologists,
hepatologists, endocrinologists, and the wider multidisciplinary team to address the need for earlier identification of those
with MASLD who are at increased risk for CVD. The overlap in the pathophysiologic processes and parallel prevalence of
CVD, metabolic syndrome, and MASLD highlight the multisystem consequences of poor cardiovascular–liver–metabolic
health. Metabolic dysfunction and associated insulin resistance, together with the predilection for ectopic fat deposition
in the liver and surrounding tissues, are associated with elevated risk of endothelial dysfunction, systemic inflammatory
response, and ectopic fat deposition in the epicardium. This complex pathophysiology can accelerate atherogenic
dyslipidemia, atherogenesis, diastolic dysfunction, valvular calcification, and cardiac arrhythmias. Despite the mounting
evidence of mechanistic pathways underpinning MASLD and CVD, current recommendations have not clearly focused upon
MASLD as a risk factor or target for intervention in CVD. We have brought together a diverse range of international experts
committed to promoting cardiovascular–liver–metabolic health and related outcomes across the globe. The overarching goal
of this document is to offer a construct for clinicians in the cardiovascular field with regards to (1) diagnosis and screening
of MASLD through the use of noninvasive serum and imaging tests; (2) screening for CVD in all individuals with MASLD
regardless of established atherosclerotic risk factors; and (3) the approach to management of MASLD with respect to
prevention of CVD through lifestyle, as well as pharmacologic and surgical strategies. To achieve this, the modified Delphi
method was applied and a series of evidence-based quality standard recommendations have been identified.
(MASLD) and its connection to cardiovascular disease (CVD). This has catalyzed collaboration between cardiologists,
hepatologists, endocrinologists, and the wider multidisciplinary team to address the need for earlier identification of those
with MASLD who are at increased risk for CVD. The overlap in the pathophysiologic processes and parallel prevalence of
CVD, metabolic syndrome, and MASLD highlight the multisystem consequences of poor cardiovascular–liver–metabolic
health. Metabolic dysfunction and associated insulin resistance, together with the predilection for ectopic fat deposition
in the liver and surrounding tissues, are associated with elevated risk of endothelial dysfunction, systemic inflammatory
response, and ectopic fat deposition in the epicardium. This complex pathophysiology can accelerate atherogenic
dyslipidemia, atherogenesis, diastolic dysfunction, valvular calcification, and cardiac arrhythmias. Despite the mounting
evidence of mechanistic pathways underpinning MASLD and CVD, current recommendations have not clearly focused upon
MASLD as a risk factor or target for intervention in CVD. We have brought together a diverse range of international experts
committed to promoting cardiovascular–liver–metabolic health and related outcomes across the globe. The overarching goal
of this document is to offer a construct for clinicians in the cardiovascular field with regards to (1) diagnosis and screening
of MASLD through the use of noninvasive serum and imaging tests; (2) screening for CVD in all individuals with MASLD
regardless of established atherosclerotic risk factors; and (3) the approach to management of MASLD with respect to
prevention of CVD through lifestyle, as well as pharmacologic and surgical strategies. To achieve this, the modified Delphi
method was applied and a series of evidence-based quality standard recommendations have been identified.
| Original language | English |
|---|---|
| Journal | Circulation |
| DOIs | |
| Publication status | Accepted/In press - 10 Sept 2024 |
