Cardiovascular Implications in Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD): A State-of-the-Art Review
Mithil Gowda Suresh, Safia Mohamed, Harinivaas Shanmugavel Geetha, Sushmita Prabhu, Nitin Trivedi, Priyal Mehta, Udaya Kumar Damodaran, Ajit Singh, Aalam Sohal, Juniali Hatwal, Akash Batta
Abstract
Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD) is the most prevalent chronic liver disease globally and a key driver of cardiometabolic morbidity. Beyond hepatic manifestations, MASLD significantly elevates the risk of cardiovascular disease (CVD)-including myocardial infarction, ischemic stroke, heart failure, and cardiovascular mortality-through overlapping mechanisms such as visceral adiposity, insulin resistance, inflammation, oxidative stress, and dyslipidemia. Epidemiologic data demonstrate a consistent and independent association between MASLD and adverse cardiovascular outcomes. Subclinical changes in vascular structure and function precedes overt events, underscoring the need for early detection and proactive risk stratification. While glucagon-like-peptide 1 receptor agonists and sodium-glucose co-transporter-2 inhibitors offer dual hepatic and cardiovascular benefits, recent trials have revealed nuances in efficacy across patient populations, particularly in heart failure with preserved ejection fraction and cirrhotic cohorts. Non-invasive diagnostics-including elastography, magnetic resonance elastography, magnetic resonance imaging-derived proton density fat fraction, and machine learning-based tools-are enhancing the precision of MASLD staging and risk assessment. However, implementation remains variable, and cost-effectiveness in CVD screening is underexplored. This review synthesizes current knowledge on the MASLD-CVD interface, critically appraises existing evidence, and identifies gaps in mechanistic understanding, diagnostics, and therapeutics. We advocate for an integrated, multidisciplinary framework combining hepatology and cardiology expertise to optimize patient care in this evolving disease landscape.