Cardiovascular-Liver-Metabolic Health: Recommendations in Screening, Diagnosis, and Management of Metabolic Dysfunction-Associated Steatotic Liver Disease in Cardiovascular Disease via Modified Delphi Approach

  • Circulation. 2025 Jan 7;151(1):98-119. doi: 10.1161/CIRCULATIONAHA.124.070535.
Nicholas W S Chew  #  1  2 ,  Anurag Mehta  #  3 ,  Rachel Sze Jen Goh  2 ,  Audrey Zhang  1 ,  Yiming Chen  2 ,  Bryan Chong  2 ,  Han Shi Jocelyn Chew  4 ,  Asim Shabbir  5 ,  Adrian Brown  6 ,  Georgios K Dimitriadis  7 ,  Daniel Q Huang  8  2  9 ,  Roger Foo  1  2 ,  Carel W le Roux  10 ,  Gemma A Figtree  11 ,  Marat Fudim  12 ,  Ambarish Pandey  13 ,  Mamas A Mamas  14 ,  Derek J Hausenloy  2  15  16 ,  A Mark Richards  17  18 ,  Stephen J Nicholls  19 ,  Mark Y Chan  1  2 ,  Mark D Muthiah  8  2  9 ,  Arun Sanyal  20 ,  Laurence S Sperling  21
Affiliations
  • 1. Department of Cardiology, National University Heart Centre (N.W.S.C., A.Z., R.F., M.Y.C.), National University Health System, Singapore.
  • 2. Yong Loo Lin School of Medicine (N.S.W.C., R.G., Y.C., B.C., D.Q.H., R.F., M.Y.C., M.M., D.J.H.), National University of Singapore, Singapore.
  • 3. Virginia Commonwealth University Health Pauley Heart Center, Division of Cardiology (A.M.), Department of Internal Medicine, Virginia Commonwealth University School of Medicine, Richmond.
  • 4. Alice Lee Centre for Nursing Studies (J.C.), National University of Singapore, Singapore.
  • 5. National University of Singapore, Department of Surgery (A.Shabbir), National University Hospital, Singapore.
  • 6. University College London Centre for Obesity Research; Bariatric Centre for Weight Management and Metabolic Surgery, University College London Hospital NHS Trust; and National Institute of Health Research, UCLH Biomedical Research Centre, London, UK (A.B.).
  • 7. Department of Endocrinology ASO/EASO COM, King's College Hospital NHS Foundation Trust; and Faculty of Cardiovascular Medicine and Sciences, Department of Diabetes, Obesity, Type 2 Diabetes and Immunometabolism Research Group, School of Life Course Sciences, King's College, London, UK (G.K.D.).
  • 8. National University Centre for Organ Transplantation (D.Q.H., M.M.), National University Health System, Singapore.
  • 9. Division of Gastroenterology and Hepatology, Department of Medicine (D.Q.H., M.M.), National University Hospital, Singapore.
  • 10. Diabetes Complications Research Centre, University College Dublin, Ireland (C.R.l.R.).
  • 11. Department of Cardiology, Royal North Shore Hospital, Australia (G.A.F.).
  • 12. Duke University Medical Center; and Duke Clinical Research Institute, Durham, NC (M.F.).
  • 13. Department of Internal Medicine, Division of Cardiology, University of Texas Southwestern Medical Center, Dallas (A.P.).
  • 14. Keele Cardiovascular Research Group, School of Medicine, Keele University, UK (M.A.M.).
  • 15. Duke-NUS Medical School, Cardiovascular and Metabolic Disorders Programme; and National Heart Centre Singapore, National Heart Research Institute, Singapore (D.J.H.).
  • 16. University College London, The Hatter Cardiovascular Institute, UK (D.J.H.).
  • 17. Christchurch Heart Institute, University of Otago, New Zealand (A.M.R.).
  • 18. Cardiovascular Research Institute, National University Heart Centre Singapore, Singapore (A.M.R.).
  • 19. Victorian Heart Institute, Monash University, Australia (S.J.N.).
  • 20. Division of Gastroenterology, Hepatology and Nutrition (A.Sanyal), Department of Internal Medicine, Virginia Commonwealth University School of Medicine, Richmond.
  • 21. Division of Cardiology, Department of Medicine, Emory Clinical Cardiovascular Research Institute; and Emory University School of Medicine, Atlanta, GA (L.S.S.).
  • # Contributed equally.
PMID: 39723980 DOI: 10.1161/CIRCULATIONAHA.124.070535
Abstract

There is a new awareness of the widespread nature of metabolic dysfunction-associated steatotic Liver Disease (MASLD) and its connection to Cardiovascular Disease (CVD). This has catalyzed collaboration between cardiologists, hepatologists, endocrinologists, and the wider multidisciplinary team to address the need for earlier identification of those with MASLD who are at increased risk for CVD. The overlap in the pathophysiologic processes and parallel prevalence of CVD, metabolic syndrome, and MASLD highlight the multisystem consequences of poor cardiovascular-liver-metabolic health. Metabolic dysfunction and associated Insulin Resistance, together with the predilection for ectopic fat deposition in the liver and surrounding tissues, are associated with elevated risk of endothelial dysfunction, systemic inflammatory response, and ectopic fat deposition in the epicardium. This complex pathophysiology can accelerate atherogenic dyslipidemia, atherogenesis, diastolic dysfunction, valvular calcification, and cardiac Arrhythmias. Despite the mounting evidence of mechanistic pathways underpinning MASLD and CVD, current recommendations have not clearly focused upon MASLD as a risk factor or target for intervention in CVD. We have brought together a diverse range of international experts committed to promoting cardiovascular-liver-metabolic health and related outcomes across the globe. The overarching goal of this document is to offer a construct for clinicians in the cardiovascular field with regards to (1) diagnosis and screening of MASLD through the use of noninvasive serum and imaging tests; (2) screening for CVD in all individuals with MASLD regardless of established atherosclerotic risk factors; and (3) the approach to management of MASLD with respect to prevention of CVD through lifestyle, as well as pharmacologic and surgical strategies. To achieve this, the modified Delphi method was applied and a series of evidence-based quality standard recommendations have been identified.

Keywords
atherosclerosis; cardiovascular diseases; fatty liver; isk factors; liver diseases; metabolic syndrome.