Hormonal
Metabolic dysfunction-associated steatotic liver disease (MASLD) is strongly associated with increased subclinical atherosclerosis (measured by carotid intima-media thickness and coronary artery calcification) and incident cardiovascular events, but does not independently increase cardiovascular mortality risk after adjusting for confounders.
If you have MASLD, prioritize cardiovascular risk management (blood pressure, lipids, glucose) as aggressively as you manage your liver health. Your risk of heart events is elevated, but your risk of dying from liver failure is lower than dying from heart disease. Comprehensive cardiometabolic risk management is warranted.
Taken together, strong evidence exists that MASLD gives an increased risk of asCVD events and asCVD is the main cause of death in patients with MASLD, not liver-related causes. Yet MASLD conveying an increased risk of asCVD death. MASLD is a spectrum of liver disease... this does not translate into MASLD conveying an increased risk of asCVD death.
Why this rating
Based on multiple large systematic reviews and meta-analyses with tens of thousands of subjects, though causality for mortality remains unproven.
Source
Metabolic dysfunction-associated steatotic liver disease and the heart
Stan Driessen et al. · Hepatology · 2023
DOI 10.1097/hep.0000000000000735
More from this paper
- Advanced stages of MASLD (fibrosis/MASH) causally contribute to heart failure with preserved ejection fraction (HFpEF) through mechanical impediments to hepatic blood flow, reducing right ventricular preload.Moderate
- Mendelian randomization studies suggest that genetic predisposition to MASLD via impaired VLDL secretion (PNPLA3, TM6SF2) may lower plasma lipids and potentially reduce coronary artery disease risk, whereas other MASLD genes show weak or no association with CAD.Moderate
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This is one finding among thousands. Every one is graded and traced to its source, so you can see what the evidence actually supports. Browse the research →