Expose MASH [Formerly NASH]

Cardiovascular Disease and the Liver: A Unified Approach for MASH

Episode Summary

In this episode of Expose MASH [formerly NASH]—intended for US healthcare professionals only—we break down the connection between liver and heart disease, focusing on how MASH (metabolic dysfunction-associated steatohepatitis) can increase the risk of cardiovascular disease, and how addressing MASH can help by treating risk factors common to heart disease and MASLD can benefit both heart and liver. We explore why patients with MASH face higher mortality rates, often due to cardiovascular complications, and discuss the importance of integrated care between hepatologists and cardiologists. This episode is brought to you by Novo Nordisk Inc.

Episode Notes

In this episode, join experts Nadege Gunn, MD, (Medical Director & Senior Scientific Advisor at Velocity Clinical Research, Waco, TX), Jorge Plutzky, MD, (Director at Preventive Cardiology Brigham and Women’s Hospital, Boston, MA), and moderator Mohammad Siddiqui, MD (Professor of Medicine at Virginia Commonwealth University, Richmond, VA), as they explore the connection between liver and cardiovascular health. Our experts will discuss how the prevalence of MASH is increased in patients with cardiovascular disease, and is associated with a higher risk of cardiovascular complications and increased mortality rates. Experts will explain why managing MASH requires a multidisciplinary approach, integrating both hepatology and cardiology—among other specialties—to effectively reduce liver-related and cardiovascular risks. Tune in to learn how managing both MASH and cardiovascular disease together is key to improving outcomes for these patients and why understanding this link is essential for medical professionals and patients alike.

This program is intended for clinicians in the US only. The information presented is aligned with the views and opinions of the speakers and is sponsored by Novo Nordisk Inc. This podcast is not to be used as medical advice and is intended for educational purposes only.

Faculty Presenters:
Nadege Gunn, MD
Medical Director & Senior Scientific Advisor
Velocity Clinical Research
Waco, TX

Jorge Plutzky, MD
Director, Preventive Cardiology
Brigham and Women’s Hospital
Boston, MA

Mohammad Siddiqui, MD
Professor of Medicine
Virginia Commonwealth University
Richmond, VA

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References

Adams LA, Anstee QM, Tilg H, Targher G. Non-alcoholic fatty liver disease and its relationship with cardiovascular disease and other extrahepatic diseases. Gut. 2017;66(6):1138-1153.

Ajmal MR, Yaccha M, Malik MA, et al. Prevalence of nonalcoholic fatty liver disease (NAFLD) in patients of cardiovascular diseases and its association with hs-CRP and TNF-α. Indian Heart J. 2014;66(6):574-579.

Allen AM, Charlton M, Cusi K, et al. Guideline-based management of metabolic dysfunction-associated steatotic liver disease in the primary care setting. Postgrad Med. 2024;136(3):229-245.

Aminian A, Al-Kurd A, Wilson R, et al. Association of bariatric surgery with major adverse liver and cardiovascular outcomes in patients with biopsy-proven nonalcoholic steatohepatitis. JAMA. 2021;326(2):2031-2042.

Chakravarthy MV, Neuschwander-Tetri BA. The metabolic basis of nonalcoholic steatohepatitis. Endocrinol Diabetes Metab. 2020;3(4):e00112.

Cusi K, Isaacs S, Barb D, et al. American Association of Clinical Endocrinology Clinical Practice Guideline for the diagnosis and management of nonalcoholic fatty liver disease in primary care and endocrinology clinical settings. Endocr Pract. 2022;28(5):528-562. 

Duell PB, Welty FK, Miller M, et al. Nonalcoholic fatty liver disease and cardiovascular risk: a scientific statement from the American Heart Association. Arterioscler Thromb Vasc Biol. 2022;42(6):e168-e185.

Ekstedt M, Hagstrom H, Nasr P, et al. Fibrosis stage is the strongest predictor for disease-specific mortality in NAFLD after up to 33 years of follow-up. Hepatology. 2015;61(5):1547-1554.

Estes C, Razavi H, Loomba R, Younossi Z, Sanyal AJ. Modeling the epidemic of nonalcoholic fatty liver disease demonstrates an exponential increase in burden of disease. Hepatology. 2018;67(1):123-133.

Godoy-Matos AF, Silva Júnior WS, Valerio CM. NAFLD as a continuum: from obesity to metabolic syndrome and diabetes. Diabetol Metab Syndr. 2020;12:60.

Kanwal F, Shubrook JH, Adams LA, et al. Clinical care pathway for the risk stratification and management of patients with nonalcoholic fatty liver disease. Gastroenterology. 2021;161(5):1657-1669.

Khan SS, Ning H, Wilkins JT, et al. Association of body mass index with lifetime risk of cardiovascular disease and compression of morbidity. JAMA Cardiol. 2018;3(4):280-287.

Lau DCW, Wharton S. Canadian Adult Obesity Clinical Practice Guidelines: The science of obesity. Accessed 14 February 2025. Available from: https://obesitycanada.ca/guidelines/science

Mantovani A, Ballestri S, Lonardo A, Targher G. Cardiovascular disease and myocardial abnormalities in nonalcoholic fatty liver disease. Dig Dis Sci. 2016;61(5):1246-1267.

Muthiah MD, Cheng Han N, Sanyal AJ. A clinical overview of non-alcoholic fatty liver disease: a guide to diagnosis, the clinical features, and complications-What the non-specialist needs to know. Diabetes Obes Metab. 2022;24(Suppl 2):3-14.

Ng CH, Lim WH, Hui Lim GE, et al. Mortality outcomes by fibrosis stage in nonalcoholic fatty liver disease: a systematic review and meta-analysis. Clin Gastroenterol Hepatol. 2023;21(4):931-939.

Piao C, Arteaga EJ, Chen S, Guo A, Macdonald ST, Sarkar S. Improved detection of fibrotic nonalcoholic fatty liver disease in community-based referrals. Metab Syndr Relat Disord. 2023;21(9):475-478.

Rinella ME, Neuschwander-Tetri BA, Siddiqui MS, et al. AASLD Practice Guidance on the clinical assessment and management of nonalcoholic fatty liver disease. Hepatology. 2023;77(5):1797-1835. 

Sanyal AJ, Husain M, Diab C, et al. Cardiovascular disease in patients with metabolic dysfunction-associated steatohepatitis compared with metabolic dysfunction-associated steatotic liver disease and other liver diseases: a systematic review. Am Heart J Plus. 2024;41:100386.

Schattenberg JM, Lazarus JV, Newsome PN, et al. Disease burden and economic impact of diagnosed non-alcoholic steatohepatitis in five European countries in 2018: a cost-of-illness analysis. Liver Int. 2021;41(6):1227-1242.

Shroff H, Van Wagner LB. Cardiovascular disease in nonalcoholic steatohepatitis: screening and management. Curr Hepatol Rep. 2020;19(3):315-326.

Targher G, Byrne CD, Lonardo A, Zoppini G, Barbui C. Non-alcoholic fatty liver disease and risk of incident cardiovascular disease: a meta-analysis. J Hepatol. 2016;65(3):589-600.

Vilar-Gomez E, Martinez-Perez Y, Calzadilla-Bertot L, et al. Weight loss through lifestyle modification significantly reduces features of nonalcoholic steatohepatitis. Gastroenterology. 2015;149(2):367-378.

Yang Z, Tian R, Zhang XJ, Cai J, She ZG, Li H. Effects of treatment of non-alcoholic fatty liver disease on heart failure with preserved ejection fraction. Front Cardiovasc Med. 2023;9:1120085.

Younossi ZM, Golabi P, Paik JM, Henry A, van Dongen C, Henry L. The global epidemiology of nonalcoholic fatty liver disease (NAFLD) and nonalcoholic steatohepatitis (NASH): a systematic review. Hepatology. 2023;77(4):1335-1347.