Metabolic dysfunction-associated steatotic liver disease: a silent driver of cardiovascular risk and a new target for intervention

Metabolic dysfunction-associated steatotic liver disease (MASLD) significantly increases the risk of steatohepatitis and cirrhosis and multiple extrahepatic complications, in particular, cardiometabolic disease, including type 2 diabetes, atherosclerotic cardiovascular disease (CVD), and heart failure, with a significant negative impact on health-related quality of life, becoming a substantial economic burden. Moreover, cardiovascular events represent the leading cause of death in MASLD patients. A timely diagnosis stratifies patient for their risk. It can facilitate early lifestyle changes or pharmacological management of dysmetabolic conditions, thereby slowing disease progression, lowering cardiovascular risk, and preventing CVD and cirrhosis. In this narrative review, we will discuss the current knowledge on MASLD and metabolic dysfunction-associated steatohepatitis (MASH) pathophysiology, emphasizing their systemic nature, the link to CVD, and available and emerging treatment strategies.