Integrating liver and heart health: Cardiovascular risk reduction in patients with metabolic-associated steatotic liver disease

Table 1 Comparative hepatocardiac effects of pharmacologic therapies in metabolic dysfunction–associated steatotic liver disease

Drug class	Hepatic effects	Cardiovascular effects	Clinical notes
GLP-1 receptor agonists	Improves liver histology, reduces inflammation; supports weight loss	Reduces major adverse cardiovascular events	First-line in MASLD with type 2 diabetes mellitus or obesity; safe in compensated cirrhosis
SGLT2 inhibitors	Reduces hepatic steatosis, improves liver enzymes	Decreases heart failure hospitalizations, cardiorenal protection	Superior cardiovascular benefits; potential synergy with GLP-1RAs
Statins	Safe, may improve liver enzymes	Significantly reduces cardiovascular events	Preferred in MASLD with CV risk; avoid in decompensated cirrhosis
THR-β agonists	Markedly improves liver fibrosis	Limited cardiovascular data available	Promising but requires further research
PPAR agonists	Improves hepatic inflammation	Variable effects depending on specific agent	Pioglitazone beneficial in diabetic patients
Metformin	No improvement in liver histology	Beneficial for diabetic patients	Not recommended for MASLD alone

MASLD: Metabolic dysfunction-associated steatotic liver disease; THR-β: Thyroid hormone receptor-β; PPAR: Peroxisome proliferator-activated receptor.