Clinical Scorecard: Exploring the Role of MASLD within the Cardiovascular-Kidney-Metabolic Health Framework: Insights and Implications
At a Glance
Category
Detail
Condition
Metabolic dysfunction–associated steatotic liver disease (MASLD) within cardiovascular–kidney–metabolic (CKM) syndrome
Key Mechanisms
Interplay of excess/dysfunctional adiposity, insulin resistance, hypertension, dyslipidaemia, diabetes, and impaired kidney function driving cardiovascular and kidney disease; MASLD defined by hepatic steatosis plus metabolic dysfunction
Target Population
Adults with metabolic risk factors, including those with hepatic steatosis and CKM syndrome stages 0–4
Care Setting
Cardiovascular and metabolic disease prevention and management settings, including primary care and specialty clinics
Key Highlights
CKM syndrome is a multisystem disorder with five stages based on severity and risk, integrating cardiovascular, kidney, and metabolic axes.
MASLD requires metabolic dysfunction plus hepatic steatosis and is associated with higher cardiovascular disease risk across CKM stages.
Fatty liver index (FLI) ≥ 60 correlates with increased cardiovascular events risk, especially in early CKM stages, but its clinical utility as a hepatic steatosis marker is limited.
Guideline-Based Recommendations
Diagnosis
MASLD diagnosis requires evidence of hepatic steatosis plus at least one metabolic risk factor.
FLI can be used in large-scale epidemiological studies but is not currently recommended for individual clinical diagnosis of hepatic steatosis.
Management
CKM staging guides therapies with proven cardiovascular benefit including statins, RAAS inhibitors, SGLT2 inhibitors, and GLP-1 receptor agonists.
Emerging MASLD treatments such as resmetirom show promise for histologic resolution of steatohepatitis and fibrosis improvement.
Monitoring & Follow-up
Life-course-based screening and stage-specific risk prediction are recommended for early detection and intervention in CKM and MASLD.
Monitoring should consider metabolic risk factors progression to inform primordial and primary cardiovascular prevention.
Overlap of metabolic dysfunction components in MASLD and CKM may complicate risk stratification and treatment decisions.
Patient & Prescribing Data
Korean adults (n=1,497,913) followed for 12.6 years with varying CKM stages and FLI scores
Higher FLI associated with 32% increased hazard of cardiovascular events; relative risk greater in early CKM stages, suggesting potential benefit of early risk stratification and intervention.
Clinical Best Practices
Incorporate metabolic risk factor assessment in patients with hepatic steatosis to identify MASLD and CKM stages.
Use CKM staging to guide cardiovascular and kidney disease prevention therapies with established benefits.
Recognize limitations of FLI for individual diagnosis; consider comprehensive clinical evaluation for hepatic steatosis.
Prioritize primordial and primary prevention strategies in patients with MASLD to reduce cardiovascular risk.
Stay informed on emerging MASLD-specific therapies and their integration with CKM management.
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