Key result
Select HFrEF therapies, including RAS inhibitors, MRAs, and SGLT2 inhibitors, reduce liver fibrosis and hepatic steatosis.
Why the study?
HFrEF and NAFLD share pathophysiological mechanisms, prompting growing interest in targeted therapies to improve outcomes in patients with both conditions.
What are the current and potential therapies that improve hepatic and cardiovascular outcomes in patients with coexisting HFrEF and NAFLD?
What are the current and potential therapies that improve hepatic and cardiovascular outcomes in patients with coexisting HFrEF and NAFLD?
This review highlights that foundational HFrEF therapies—specifically ACE inhibitors, ARBs, MRAs, and SGLT2 inhibitors—alongside lifestyle modification, statins, and bariatric surgery offer dual benefits for patients with coexisting HFrEF and NAFLD, while thiazolidinediones should be avoided.
May support dual-benefit consideration of select HFrEF therapies in NAFLD; leaves open need for randomized confirmation.
Heart failure with reduced ejection fraction (HFrEF) and nonalcoholic fatty liver disease (NAFLD) are two common comorbidities that share similar pathophysiological mechanisms. There is a growing interest in the potential of targeted therapies to improve outcomes in patients with coexisting HFrEF and NAFLD. This manuscript reviews current and potential therapies for patients with coexisting HFrEF and NAFLD. Pharmacological therapies, including angiotensin-converting enzyme inhibitors/angiotensin receptor blockers, mineralocorticoids receptor antagonist, and sodium-glucose cotransporter-2 inhibitors, have been shown to reduce fibrosis and fat deposits in the liver. However, there are currently no data showing the beneficial effects of sacubitril/valsartan, ivabradine, hydralazine, isosorbide nitrates, digoxin, or beta blockers on NAFLD in patients with HFrEF. This study highlights the importance of considering HFrEF and NAFLD when developing treatment plans for patients with these comorbidities. Further research is needed in patients with coexisting HFrEF and NAFLD, with an emphasis on novel therapies and the importance of a multidisciplinary approach for managing these complex comorbidities.
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Arriola‐Montenegro et al. (2023) conducted a review in Coexisting heart failure with reduced ejection fraction (HFrEF) and nonalcoholic fatty liver disease (NAFLD). Pharmacological, non-pharmacological, and surgical therapies (including ACE inhibitors, ARBs, MRAs, SGLT2 inhibitors, dietary changes, and bariatric surgery) was evaluated on Liver fibrosis, hepatic steatosis, and heart failure clinical outcomes. ACE inhibitors, ARBs, MRAs, and SGLT2 inhibitors reduce liver fibrosis and fat deposits in patients with coexisting HFrEF and NAFLD, whereas sacubitril/valsartan and beta-blockers lack NAFLD data.
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