Metabolic Liver AcademyHealthy liver. Healthy life.
العربية

Quick reference

Heart and metabolic care in MASLD

Heart disease, not liver disease, is the top cause of death in most MASLD patients.

For
Healthcare professionals
Author
Dr. Mahmoud Al-Desoky
Version
1.0, updated 2026-10-03

Key points

  • Assess and treat cardiovascular risk in every patient.
  • Statins are safe in MASLD and should not be withheld.
  • In type 2 diabetes, favour drugs with liver and heart benefit (GLP-1 RA, SGLT2i, pioglitazone).
  • MASLD raises the risk of type 2 diabetes and chronic kidney disease.

For the evidence, graded recommendations, a case and self-test questions, read Module 4: MASLD in the diabetes clinic.

1What to check

  • Blood pressure, lipid profile, HbA1c or fasting glucose.
  • Kidney function and urine albumin in diabetes.
  • Smoking, sleep apnoea symptoms.
  • A 10-year cardiovascular risk score.

2Statins

Raised liver enzymes are not a reason to avoid statins. They are safe in compensated cirrhosis. Use care in decompensated cirrhosis.

3Diabetes drugs

GLP-1 receptor agonists and pioglitazone improve liver histology. SGLT2 inhibitors protect heart and kidney. Metformin is safe but does not treat the liver. In decompensated cirrhosis, insulin is often the safest choice.

Related topics

References

  1. EASL–EASD–EASO Clinical Practice Guidelines on the management of MASLD. J Hepatol 2024;81:492–542. doi:10.1016/j.jhep.2024.04.031
  2. Rinella ME, et al. AASLD Practice Guidance on the clinical assessment and management of NAFLD. Hepatology 2023;77:1797–835. doi:10.1097/HEP.0000000000000323
  3. Cusi K, et al. AACE clinical practice guideline for the diagnosis and management of NAFLD in primary care and endocrinology clinical settings. Endocr Pract 2022;28:528–62. doi:10.1016/j.eprac.2022.03.010
  4. Younossi ZM, et al. Global consensus recommendations for MASLD and MASH. Gastroenterology 2025;169(5):1017–32. doi:10.1053/j.gastro.2025.02.044

How to cite this page

Desoky M. Heart and metabolic care in MASLD. Metabolic Liver Academy quick reference, version 1.0. Updated 2026-10-03. Available from: https://drmahmouddesoky.github.io/metabolic-liver-academy/ref/cardiometabolic.html

A summary of published guidelines for healthcare professionals. It does not replace clinical judgement, the full guidelines or local drug labels. Disclaimer.

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