Unveiling the Hidden Heart Risks: Lifestyle Interventions and Statins for Managing CVD in MASLD/MASH
Patients grappling with metabolic dysfunction-associated steatotic liver disease (MASLD) or its severe variant, metabolic dysfunction-associated steatohepatitis (MASH), face a startling reality— an elevated risk for cardiovascular complications. A recent enlightening review in Current Cardiology Reports highlighted the duality of pharmacological and lifestyle interventions as key measures in mitigating cardiovascular risk in these patients.
Understanding the Connection Between MASLD/MASH and CVD
To identify MASLD, individuals must present with at least one additional cardiometabolic risk factor such as high blood pressure, diabetes, or obesity. This combination creates a Pro-Atherogenic Milieu filled with systemic inflammation, endothelial dysfunction, and oxidative stress, closely mirroring the pathophysiology of cardiovascular disease (CVD). Research indicates that those with MASLD have a 64% higher incidence of CVD—a striking statistic that underscores the pressing need for multifaceted treatment strategies.
Are Clinical Guidelines Keeping Up?
In the face of these findings, a gap persists within clinical guidelines. While the 2023 ESC Guidelines on cardiovascular disease predominantly emphasize traditional risk factors, many experts argue that MASLD should also be recognized as an independent CVD risk factor. This inconsistency has sparked discussions among leading organizations such as the European Society of Cardiology (ESC) and the American Heart Association about the need for frequent cardiovascular risk assessments and proactive intervention strategies.
Power of Lifestyle Changes
Why Diet and Exercise Matter
The review spotlights the transformative potential of combining dietary adjustments and increased physical activity. Studies reveal that lower-caloric diets can not only foster improvements in cardiovascular health but also significantly alter the landscape of MASLD/MASH risk factors. In fact, incorporating approximately 150 minutes of physical activity weekly is recommended, demonstrating a positive impact on fatty liver disease management.
- Weight Loss as a Catalyst: Achieving sufficient weight loss can drastically improve liver health markers. More pronounced benefits are visible in individuals who experience substantial weight reduction, making lifestyle modifications essential for both cardiovascular and liver health.
The Role of Statins in Treatment
First-Line Therapy and Its Underutilization
Statins remain the cornerstone of pharmacological treatment for MASLD, particularly for those battling dyslipidemia. These medications are critical for managing CVD risk; however, alarmingly, nearly 50% of eligible patients do not receive statin therapy, mainly due to elevated transaminases and insufficient awareness among healthcare providers regarding liver steatosis.
This poses a therapeutic dilemma in clinical practice. It’s essential to recognize that elevated transaminases are often a direct consequence of the underlying liver condition driven by cardiometabolic risk factors. Therefore, mild increases in these liver enzymes should not deter the initiation or continuation of statin therapy.
Exploring Emerging Options
The authors of the review also referenced promising alternatives such as bariatric surgery, peroxisome proliferator-activated receptor agonists, and GLP-1 receptor agonists as potential adjunct treatments for MASLD/MASH. Research backing the lipid-specific benefits of GLP-1 receptor agonists highlights an exciting new frontier in managing this complex condition.
As more phase 3 clinical data emerges, healthcare professionals eagerly anticipate broader implementation of these therapies within the hepatological treatment landscape.
Conclusion: A Comprehensive Approach to Prevention
In summary, the convergence of lifestyle interventions and statin therapy represents a proactive approach to diminishing cardiovascular risks in patients with MASLD/MASH. Regular assessments and personalized treatment plans that include dietary management and physical activity can cultivate healthier futures for individuals navigating these complex health challenges.
References
- Bernhard J, Galli L, Speidl WS, Krychtiuk KA. Cardiovascular risk reduction in metabolic dysfunction-associated steatotic liver disease and metabolic dysfunction-associated steatohepatitis. Curr Cardiol Rep. 2025;27(1):28. doi:10.1007/s11886-024-02185-5
- Targher G, Byrne CD, Lonardo A, Zoppini G, Barbui C. Non-alcoholic fatty liver 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
- Duell PB, Welty FK, Miller M, et al. Nonalcoholic fatty liver disease and cardiovascular risk: a scientific statement from the American Heart Association. Arterioscler Thromb Vasc Biol. 2022 Jun;42(6):e168-e185. doi:10.1161/ATV.0000000000000153
- Sung KC, Ryu S, Lee JY, Kim JY, Wild SH, Byrne CD. Effect of exercise on the development of new fatty liver and the resolution of existing fatty liver. J Hepatol. 2016;65(4):791-797. doi:10.1016/j.jhep.2016.05.026
- Blais P, Lin M, Kramer JR, El-Serag HB, Kanwal F. Statins are underutilized in patients with nonalcoholic fatty liver disease and dyslipidemia. Dig Dis Sci. 2016;61(6):1714-20. doi:10.1007/s10620-015-4000-6
By educating ourselves and embracing these strategies, we can collectively move toward a future wherein the dual threats of MASLD/MASH and cardiovascular disease are effectively managed, enhancing overall health and well-being.
