Lean MASLD and Cardiovascular Disease: A Review

Area of Science:

• Hepatology
• Cardiology
• Metabolic Disorders

Background:

• Metabolic-associated steatotic liver disease (MASLD), previously nonalcoholic fatty liver disease, is a global health concern linked to cardiovascular disease (CVD).
• Lean MASLD, characterized by hepatic steatosis and cardiometabolic risk factors in normal-weight individuals, presents a paradox of elevated cardiovascular risk compared to nonlean MASLD.
• Distinct metabolic, genetic, and microbiome profiles in lean MASLD contribute to visceral adiposity, sarcopenia, fibrosis, inflammation, and endothelial dysfunction.

Purpose of the Study:

• To review the epidemiology, pathophysiology, and cardiovascular outcomes of lean MASLD.
• To address existing discrepancies in the literature regarding lean MASLD and cardiovascular risk.
• To highlight current clinical guidelines, lifestyle modifications, and emerging pharmacotherapies for lean MASLD.

Main Methods:

• Literature review of epidemiological data.
• Analysis of pathophysiological mechanisms.
• Examination of clinical guidelines and emerging treatments.

Main Results:

• Lean MASLD is associated with increased visceral adiposity, sarcopenia, hepatic fibrosis, systemic inflammation, and endothelial dysfunction.
• Studies suggest lean MASLD may confer a higher cardiovascular risk than nonlean MASLD.
• Distinctive patient profiles contribute to varied disease progression and outcomes.

Conclusions:

• Lean MASLD represents a critical subgroup with significant cardiovascular implications requiring targeted research and clinical attention.
• Understanding the unique pathophysiology of lean MASLD is crucial for developing effective management strategies.
• Lifestyle modifications and novel pharmacotherapies hold promise for improving cardiovascular outcomes in lean MASLD patients.