Metabolic dysfunction-associated steatotic liver disease and the heart.

IF 12.9 1区 医学 Q1 GASTROENTEROLOGY & HEPATOLOGY
Hepatology Pub Date : 2025-08-01 Epub Date: 2023-12-25 DOI:10.1097/HEP.0000000000000735
Stan Driessen, Sven M Francque, Stefan D Anker, Manuel Castro Cabezas, Diederick E Grobbee, Maarten E Tushuizen, Adriaan G Holleboom
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Abstract

The prevalence and severity of metabolic dysfunction-associated steatotic liver disease (MASLD) are increasing. Physicians who treat patients with MASLD may acknowledge the strong coincidence with cardiometabolic disease, including atherosclerotic cardiovascular disease (asCVD). This raises questions on co-occurrence, causality, and the need for screening and multidisciplinary care for MASLD in patients with asCVD, and vice versa. Here, we review the interrelations of MASLD and heart disease and formulate answers to these matters. Epidemiological studies scoring proxies for atherosclerosis and actual cardiovascular events indicate increased atherosclerosis in patients with MASLD, yet no increased risk of asCVD mortality. MASLD and asCVD share common drivers: obesity, insulin resistance and type 2 diabetes mellitus (T2DM), smoking, hypertension, and sleep apnea syndrome. In addition, Mendelian randomization studies support that MASLD may cause atherosclerosis through mixed hyperlipidemia, while such evidence is lacking for liver-derived procoagulant factors. In the more advanced fibrotic stages, MASLD may contribute to heart failure with preserved ejection fraction by reduced filling of the right ventricle, which may induce fatigue upon exertion, often mentioned by patients with MASLD. Some evidence points to an association between MASLD and cardiac arrhythmias. Regarding treatment and given the strong co-occurrence of MASLD and asCVD, pharmacotherapy in development for advanced stages of MASLD would ideally also reduce cardiovascular events, as has been demonstrated for T2DM treatments. Given the common drivers, potential causal factors and especially given the increased rate of cardiovascular events, comprehensive cardiometabolic risk management is warranted in patients with MASLD, preferably in a multidisciplinary approach.

与脂肪肝和心脏有关的代谢功能障碍。
代谢功能障碍相关性脂肪性肝病(MASLD)的发病率和严重程度都在不断增加。治疗脂肪肝患者的医生可能会承认,脂肪肝与包括动脉粥样硬化性心血管疾病(asCVD)在内的心脏代谢疾病密切相关。这就提出了一些问题,如并发症、因果关系以及是否需要筛查和多学科护理患有心血管疾病的 MASLD 患者,反之亦然。在此,我们回顾了 MASLD 与心脏病的相互关系,并就这些问题提出了答案。对动脉粥样硬化和实际心血管事件的替代物进行评分的流行病学研究表明,MASLD 患者的动脉粥样硬化程度增加,但心血管疾病的死亡风险并没有增加。MASLD和asCVD有共同的驱动因素:肥胖、胰岛素抵抗和2型糖尿病(T2DM)、吸烟、高血压和睡眠呼吸暂停综合征。此外,孟德尔随机化研究支持 MASLD 可通过混合型高脂血症导致动脉粥样硬化,而肝源性促凝血因子则缺乏此类证据。在晚期纤维化阶段,MASLD 可能会因右心室充盈减少而导致射血分数保留型心力衰竭,这可能会引起 MASLD 患者经常提到的劳累后疲劳。一些证据表明,MASLD 与心律失常有关。在治疗方面,考虑到 MASLD 和心血管疾病并发性很强,正在开发的治疗晚期 MASLD 的药物疗法最好也能减少心血管事件的发生,正如 T2DM 治疗所证明的那样。考虑到这些共同的驱动因素和潜在的致病因素,特别是考虑到心血管事件发生率的增加,有必要对 MASLD 患者进行全面的心脏代谢风险管理,最好采用多学科方法。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Hepatology
Hepatology 医学-胃肠肝病学
CiteScore
27.50
自引率
3.70%
发文量
609
审稿时长
1 months
期刊介绍: HEPATOLOGY is recognized as the leading publication in the field of liver disease. It features original, peer-reviewed articles covering various aspects of liver structure, function, and disease. The journal's distinguished Editorial Board carefully selects the best articles each month, focusing on topics including immunology, chronic hepatitis, viral hepatitis, cirrhosis, genetic and metabolic liver diseases, liver cancer, and drug metabolism.
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