Steatosic Liver Disease and Cardiovascular Diseases: Association, Prognosis and Treatment

Steatotic liver disease (SLD) is the most rapidly increasing cause of liver disease-related mortality and morbidity. The association of metabolically associated SLD with coronary heart disease is driven by shared metabolic risk factors such as obesity, diabetes, and hypertension, and there is an independent association through insulin resistance, endothelial dysfunction, oxidative stress, systemic inflammation, and atherogenic dyslipidemia. Most patients with SLD have mild steatosis, but 20-30% of patients with steatohepatitis develop progressive fibrosis, and of these, approximately 20% develop liver cirrhosis with an increased risk of transformation into hepatocellular carcinoma. Vibration-controlled transient elastography is a useful tool for detecting steatosis and the degree of fibrosis and can be used to screen for steatotic liver disease in patients with established risk factors and subclinical and clinical cardiovascular disease. For the primary prevention of cardiovascular diseases in patients with SLD, careful assessment and drug therapy of concomitant risk factors should be carried out. SLD is diagnosed by excluding other causes of liver pathology and is considered as a hepatic manifestation of the metabolic syndrome, which significantly increases the risk of cardiovascular diseases, diabetes, and impaired cerebral circulation. The criteria for the diagnosis of SLD are: the presence of hepatic steatosis, the absence of alcohol consumption, and other secondary causes of hepatic steatosis. The main method of treatment is modification of lifestyle and risk factors, which not only reduces the risk of progression of liver disease, but also the risk of developing cardiovascular complications.