This review examines recognition and management gaps in patients with coexisting chronic liver disease and cardiovascular disease, focusing on metabolic dysfunction-associated steatotic liver disease (MASLD). The authors frame MASLD as a prevalent, multisystem cardiometabolic disorder in which cardiovascular disease (CVD) is a leading contributor to morbidity and mortality. The review synthesizes current understanding of shared biology, documents sources of disparities in prevalence and care, and outlines an equity-centered approach to cardio-hepatology.
The review emphasizes overlapping metabolic and inflammatory mechanisms that connect MASLD with obesity, type 2 diabetes, hypertension, and CVD. These shared pathways provide a biologic rationale for the observed clustering of cardiometabolic conditions in affected patients and support integrated risk assessment and prevention strategies. The article cites the central role of fibrosis stage in liver prognosis and notes that cardiovascular events represent a major cause of death in MASLD populations.
Measured differences in MASLD and related cardiometabolic disease prevalence across racial and ethnic groups are highlighted, but the authors caution against attributing disparities solely to genetic susceptibility. They stress that observed prevalence variations must be considered in the context of structural inequities, diagnostic practices, and differential access to care. Socioeconomic disadvantage may limit screening, fibrosis assessment, longitudinal follow-up, and access to newer therapies; these system-level factors can amplify outcome differences between groups.
The review notes that sex and gender can introduce barriers affecting both detection and management of cardiometabolic liver disease. These barriers may relate to differences in healthcare access, clinical presentation, provider recognition, and adherence to preventive measures. The authors suggest that sex- and gender-informed strategies are required to ensure equitable identification and treatment of at-risk individuals.
Recent therapeutic developments include resmetirom and semaglutide, which have broadened treatment options for selected adults with metabolic dysfunction–associated steatohepatitis (MASH). While these agents represent an important step forward in liver-directed therapy, the review underscores that unequal access to validated fibrosis assessment, uneven insurance coverage, and gaps in longitudinal care may limit their real-world benefit across populations. Thus, therapeutic efficacy at the individual level may not translate into population-level equity unless structural barriers are addressed.
To address the combined burden of CVD and MASLD, the authors propose an equity-centered cardio-hepatology framework that integrates several components:
Early risk identification of cardiometabolic disease among individuals with MASLD and vice versa.
Stepwise, noninvasive fibrosis assessment to stratify liver disease severity and guide therapy eligibility.
Individualized cardiovascular prevention tailored to the patient’s overall cardiometabolic risk profile.
Ensuring access to indicated liver-directed therapies and appropriate longitudinal follow-up, independent of socioeconomic status or insurance variation.
The framework emphasizes that treatment and quality measures should reflect clinical eligibility—such as fibrosis stage and comorbid risk—rather than medication prescribing alone.
The review calls for inclusive research designs and coordinated long-term care models to evaluate whether equity-centered strategies reduce disparities in outcomes. Measurement approaches should capture eligibility and access, not just utilization, to avoid mischaracterizing quality of care. The authors highlight the need for studies that account for structural determinants of health, diagnostic pathways, and care continuity when interpreting racial and ethnic differences in disease burden.
The review concludes that closing gaps in recognition and management of coexisting cardiovascular and metabolic liver disease requires integration of biologic understanding with deliberate attention to structural and access-related barriers. While pharmacologic advances such as resmetirom and semaglutide expand treatment options for MASH, their potential to improve outcomes equitably depends on implementing an integrated, equity-centered approach to screening, fibrosis assessment, cardiovascular prevention, and long-term coordinated care.