Unlocking Heart Health: How Lifestyle Changes and Statins Can Lower CVD Risk in MASLD/MASH

Patients with metabolic dysfunction-associated steatotic liver disease (MASLD) or its more severe form, metabolic dysfunction-associated steatohepatitis (MASH), are at a higher risk of heart problems. A recent review in Current Cardiology Reports highlights the importance of both medication and lifestyle changes for these patients. It suggests that regular heart health assessments are crucial.

To be diagnosed with MASLD, a patient must have at least one additional cardiometabolic risk factor, such as high blood pressure, diabetes, or obesity. The review points out that the issues tied to MASLD, like inflammation and oxidative stress, closely relate to cardiovascular disease (CVD). For instance, patients with MASLD are 64% more likely to face CVD compared to those without it. Some analyses even suggest MASLD could be a standalone risk factor for heart disease.

Despite this evidence, guidelines remain conflicted. The 2021 ESC Guidelines state that traditional risk factors are the primary concern, excluding MASLD itself. However, different health organizations agree that regular cardiovascular risk assessments are essential.

The review emphasizes that lifestyle changes—like diet and exercise—can significantly improve heart health and reduce the risk factors associated with MASLD. Experts recommend at least 150 minutes of physical activity each week. This is based on studies showing that exercise can help prevent fatty liver disease.

Losing weight also plays a vital role. Studies indicate that significant weight loss can improve liver health and harm indicators. Unfortunately, many patients with MASLD and cholesterol issues do not receive statin therapy, which is the first-line treatment. Research shows that nearly half of these patients miss out on statins, often due to a lack of awareness among healthcare providers.

Interestingly, how liver enzymes respond to treatment can be complicated. Elevated enzymes often reflect the liver disease itself, driven by metabolic risk factors targeted by statins. The review encourages doctors not to shy away from prescribing statins based on minor elevations in liver enzymes.

The authors also mention new treatment options, like bariatric surgery and specific medications, are being tested for efficacy in managing MASLD/MASH. For instance, glucagon-like peptide-1 (GLP-1) receptor agonists show promise in promoting weight loss and improving liver health.

Weight control remains an essential goal, not just for managing liver disease but also for enhancing the quality of life of patients. As research continues, developing comprehensive strategies for MASLD/MASH is crucial for better health outcomes.

In summary, focusing on a healthy lifestyle, regular check-ups, and appropriate medication can significantly impact the well-being of patients battling MASLD and MASH.

For more details, you can visit the study in Current Cardiology Reports here.

References:

1. Bernhard J, et al. (2025). Cardiovascular risk reduction in metabolic dysfunction-associated steatotic liver disease and metabolic dysfunction-associated steatohepatitis. Curr Cardiol Rep.
2. Targher G, et al. (2016). Non-alcoholic fatty liver disease and risk of incident cardiovascular disease: a meta-analysis. J Hepatol.
3. Duell PB, et al. (2022). Nonalcoholic fatty liver disease and cardiovascular risk: a scientific statement from the American Heart Association. Arterioscler Thromb Vasc Biol.
4. Sung KC, et al. (2016). Effect of exercise on the development of new fatty liver and the resolution of existing fatty liver. J Hepatol.
5. Blais P, et al. (2016). Statins are underutilized in patients with nonalcoholic fatty liver disease and dyslipidemia. Dig Dis Sci.

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