Driessen Stan, Francque Sven M, Anker Stefan D, Castro Cabezas Manuel, Grobbee Diederick E, Tushuizen Maarten E, Holleboom Adriaan G
Department of Vascular Medicine, Amsterdam University Medical Center, Amsterdam, The Netherlands.
Department of Gastroenterology and Hepatology, University Hospital Antwerp, Antwerp, Belgium.
Hepatology. 2023 Dec 25. doi: 10.1097/HEP.0000000000000735.
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.
代谢功能障碍相关脂肪性肝病（MASLD）的患病率和严重程度正在上升。治疗MASLD患者的医生可能会认识到其与心脏代谢疾病，包括动脉粥样硬化性心血管疾病（asCVD）有很强的相关性。这就引发了关于asCVD患者中MASLD的共病情况、因果关系以及筛查和多学科护理需求的问题，反之亦然。在此，我们回顾MASLD与心脏病的相互关系，并对这些问题给出答案。对动脉粥样硬化代理指标和实际心血管事件进行评分的流行病学研究表明，MASLD患者的动脉粥样硬化增加，但asCVD死亡率没有增加。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可能通过混合性高脂血症导致动脉粥样硬化，而对于肝脏衍生的促凝血因子则缺乏此类证据。在更晚期的纤维化阶段，MASLD可能通过右心室充盈减少导致射血分数保留的心力衰竭，这可能会导致MASLD患者经常提到的运动时疲劳。一些证据表明MASLD与心律失常之间存在关联。关于治疗，鉴于MASLD和asCVD的强烈共病情况，针对MASLD晚期开发的药物治疗理想情况下也应减少心血管事件，就像T2DM治疗所证明的那样。鉴于共同的驱动因素、潜在的因果因素，特别是鉴于心血管事件发生率的增加，对MASLD患者进行全面的心脏代谢风险管理是必要的，最好采用多学科方法。
