---
title: "Comorbid Cardiovascular–Liver Disease Disparities: MASLD, CVD Risk, and Equity-Focused Care"
id: "pubmed-42827168"
canonical_url: "https://medichelpline.com/clinical-feed/pubmed-42827168"
content_type: "clinical_feed_article"
specialty: "Pharmacology"
source_name: "PubMed / NCBI"
source_url: "https://pubmed.ncbi.nlm.nih.gov/42827168/"
doi: "10.1007/s11886-026-02426-9"
published_at: "2026-10-03T00:00:00.000Z"
evidence_level: "Journal Article"
license: "CC-BY-NC-4.0 / Informational Use"
---
# Comorbid Cardiovascular–Liver Disease Disparities: MASLD, CVD Risk, and Equity-Focused Care
## Provenance & Clinical Metadata
- **Canonical URL:** https://medichelpline.com/clinical-feed/pubmed-42827168
- **Specialty:** [Pharmacology](https://medichelpline.com/clinical-feed/pharmacology.md)
- **Primary Source:** PubMed / NCBI
- **Source URL:** [Original Journal Publication](https://pubmed.ncbi.nlm.nih.gov/42827168/)
- **DOI:** [10.1007/s11886-026-02426-9](https://doi.org/10.1007%2Fs11886-026-02426-9)
- **Published At:** 2026-10-03T00:00:00.000Z
- **Evidence Rating:** Journal Article
## Executive GIST (TL;DR)
- Metabolic dysfunction-associated steatotic liver disease (**MASLD**) is a common chronic liver condition and a multisystem cardiometabolic disorder associated with increased **cardiovascular disease (CVD)** morbidity and mortality. - Shared metabolic and inflammatory pathways connect MASLD with obesity, type 2 diabetes, hypertension, and CVD, underscoring overlapping pathophysiology. - Observed differences in disease prevalence across racial and ethnic groups reflect not only potential biological variation but also structural inequities, diagnostic practices, and differential access to care; genetic susceptibility should be interpreted separately from these factors. - Socioeconomic disadvantage and sex- and gender-related barriers can further influence diagnosis, treatment access, and outcomes for people with coexisting cardiovascular and liver disease. - Newer therapies—**resmetirom** and **semaglutide**—have expanded treatment options for selected adults with metabolic dysfunction-associated steatohepatitis (**MASH**), but their population impact may be limited by unequal access to fibrosis assessment, insurance coverage, and longitudinal care. - The authors propose an equity-centered **cardio-hepatology** framework emphasizing early risk identification, stepwise noninvasive fibrosis assessment, individualized cardiovascular prevention, and equitable access to indicated liver-directed therapies. - Quality and treatment metrics should prioritize clinical eligibility and disease characteristics rather than relying solely on medication use as a measure of care quality. - Inclusive research, coordinated long-term care, and measurement of whether equity-centered strategies reduce disparities are needed to advance outcomes in comorbid cardiovascular-liver disease.
## Clinical Analysis & Structured Key Points
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Ibrahim.ramzi@mayo.edu.")[ 4 ](https://pubmed.ncbi.nlm.nih.gov/42827168/#full-view-affiliation-4 "Department of Cardiovascular Medicine, Mayo Clinic Arizona, 13400 East Shea Boulevard, Scottsdale, AZ, 85259, USA. Ibrahim.ramzi@mayo.edu."), [Jenna Othman](https://pubmed.ncbi.nlm.nih.gov/?term=Othman+J&cauthor_id=42827168)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42827168/#full-view-affiliation-1 "Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, AZ, USA."), [Mohamed Reyad Mohamed](https://pubmed.ncbi.nlm.nih.gov/?term=Mohamed+MR&cauthor_id=42827168)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42827168/#full-view-affiliation-2 "Department of Medicine, University of Arizona, Phoenix, AZ, USA."), [Kamal Awad](https://pubmed.ncbi.nlm.nih.gov/?term=Awad+K&cauthor_id=42827168)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42827168/#full-view-affiliation-1 "Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, AZ, USA."), [Julia Zanco](https://pubmed.ncbi.nlm.nih.gov/?term=Zanco+J&cauthor_id=42827168)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42827168/#full-view-affiliation-1 "Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, AZ, USA."), [Vinicius De Sousa Barzon Serra](https://pubmed.ncbi.nlm.nih.gov/?term=De+Sousa+Barzon+Serra+V&cauthor_id=42827168)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42827168/#full-view-affiliation-1 "Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, AZ, USA."), [Mahmoud Abdelnabi](https://pubmed.ncbi.nlm.nih.gov/?term=Abdelnabi+M&cauthor_id=42827168)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42827168/#full-view-affiliation-1 "Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, AZ, USA."), [Mahmoud Elbsiony](https://pubmed.ncbi.nlm.nih.gov/?term=Elbsiony+M&cauthor_id=42827168)[ 5 ](https://pubmed.ncbi.nlm.nih.gov/42827168/#full-view-affiliation-5 "Department of Cardiovascular Medicine, University of Arizona, Phoenix, AZ, USA."), [Said Alsidawi](https://pubmed.ncbi.nlm.nih.gov/?term=Alsidawi+S&cauthor_id=42827168)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42827168/#full-view-affiliation-1 "Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, AZ, USA."), [Steven J Lester](https://pubmed.ncbi.nlm.nih.gov/?term=Lester+SJ&cauthor_id=42827168)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42827168/#full-view-affiliation-1 "Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, AZ, USA."), [Chadi Ayoub](https://pubmed.ncbi.nlm.nih.gov/?term=Ayoub+C&cauthor_id=42827168)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42827168/#full-view-affiliation-1 "Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, AZ, USA."), [Reza Arsanjani](https://pubmed.ncbi.nlm.nih.gov/?term=Arsanjani+R&cauthor_id=42827168)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42827168/#full-view-affiliation-1 "Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, AZ, USA.") Affiliations Expand ### Affiliations * 1 Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, AZ, USA. * 2 Department of Medicine, University of Arizona, Phoenix, AZ, USA. * 3 Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, AZ, USA. Ibrahim.ramzi@mayo.edu. * 4 Department of Cardiovascular Medicine, Mayo Clinic Arizona, 13400 East Shea Boulevard, Scottsdale, AZ, 85259, USA. Ibrahim.ramzi@mayo.edu. * 5 Department of Cardiovascular Medicine, University of Arizona, Phoenix, AZ, USA. # Contributed equally. * PMID: **42827168** * DOI: [ 10.1007/s11886-026-02426-9 ](https://doi.org/10.1007/s11886-026-02426-9) Item in Clipboard Review # Comorbid Cardiovascular-Liver Disease Disparities: Current Understanding and Future Directions Abdelrahman Hafez et al. Curr Cardiol Rep. 2026. Show details Display options Display options Format Abstract PubMed PMID Curr Cardiol Rep Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Curr+Cardiol+Rep%22%5Bjour%5D&sort=date&sort_order=desc) * [ Search in NLM Catalog ](https://www.ncbi.nlm.nih.gov/nlmcatalog?term=%22Curr+Cardiol+Rep%22%5BTitle+Abbreviation%5D) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42827168/) . 2026 Oct 3;28(1):102. doi: 10.1007/s11886-026-02426-9. ### Authors [Abdelrahman Hafez](https://pubmed.ncbi.nlm.nih.gov/?term=Hafez+A&cauthor_id=42827168)[#](https://pubmed.ncbi.nlm.nih.gov/42827168/#short-view-equal-contrib-explanation "Contributed equally")[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42827168/#short-view-affiliation-1 "Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, AZ, USA.")[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42827168/#short-view-affiliation-2 "Department of Medicine, University of Arizona, Phoenix, AZ, USA."), [Mohamed Nour](https://pubmed.ncbi.nlm.nih.gov/?term=Nour+M&cauthor_id=42827168)[#](https://pubmed.ncbi.nlm.nih.gov/42827168/#short-view-equal-contrib-explanation "Contributed equally")[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42827168/#short-view-affiliation-1 "Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, AZ, USA."), [Ramzi Ibrahim](https://pubmed.ncbi.nlm.nih.gov/?term=Ibrahim+R&cauthor_id=42827168)[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42827168/#short-view-affiliation-3 "Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, AZ, USA. Ibrahim.ramzi@mayo.edu.")[ 4 ](https://pubmed.ncbi.nlm.nih.gov/42827168/#short-view-affiliation-4 "Department of Cardiovascular Medicine, Mayo Clinic Arizona, 13400 East Shea Boulevard, Scottsdale, AZ, 85259, USA. Ibrahim.ramzi@mayo.edu."), [Jenna Othman](https://pubmed.ncbi.nlm.nih.gov/?term=Othman+J&cauthor_id=42827168)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42827168/#short-view-affiliation-1 "Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, AZ, USA."), [Mohamed Reyad Mohamed](https://pubmed.ncbi.nlm.nih.gov/?term=Mohamed+MR&cauthor_id=42827168)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42827168/#short-view-affiliation-2 "Department of Medicine, University of Arizona, Phoenix, AZ, USA."), [Kamal Awad](https://pubmed.ncbi.nlm.nih.gov/?term=Awad+K&cauthor_id=42827168)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42827168/#short-view-affiliation-1 "Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, AZ, USA."), [Julia Zanco](https://pubmed.ncbi.nlm.nih.gov/?term=Zanco+J&cauthor_id=42827168)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42827168/#short-view-affiliation-1 "Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, AZ, USA."), [Vinicius De Sousa Barzon Serra](https://pubmed.ncbi.nlm.nih.gov/?term=De+Sousa+Barzon+Serra+V&cauthor_id=42827168)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42827168/#short-view-affiliation-1 "Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, AZ, USA."), [Mahmoud Abdelnabi](https://pubmed.ncbi.nlm.nih.gov/?term=Abdelnabi+M&cauthor_id=42827168)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42827168/#short-view-affiliation-1 "Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, AZ, USA."), [Mahmoud Elbsiony](https://pubmed.ncbi.nlm.nih.gov/?term=Elbsiony+M&cauthor_id=42827168)[ 5 ](https://pubmed.ncbi.nlm.nih.gov/42827168/#short-view-affiliation-5 "Department of Cardiovascular Medicine, University of Arizona, Phoenix, AZ, USA."), [Said Alsidawi](https://pubmed.ncbi.nlm.nih.gov/?term=Alsidawi+S&cauthor_id=42827168)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42827168/#short-view-affiliation-1 "Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, AZ, USA."), [Steven J Lester](https://pubmed.ncbi.nlm.nih.gov/?term=Lester+SJ&cauthor_id=42827168)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42827168/#short-view-affiliation-1 "Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, AZ, USA."), [Chadi Ayoub](https://pubmed.ncbi.nlm.nih.gov/?term=Ayoub+C&cauthor_id=42827168)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42827168/#short-view-affiliation-1 "Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, AZ, USA."), [Reza Arsanjani](https://pubmed.ncbi.nlm.nih.gov/?term=Arsanjani+R&cauthor_id=42827168)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42827168/#short-view-affiliation-1 "Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, AZ, USA.") ### Affiliations * 1 Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, AZ, USA. * 2 Department of Medicine, University of Arizona, Phoenix, AZ, USA. * 3 Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, AZ, USA. Ibrahim.ramzi@mayo.edu. * 4 Department of Cardiovascular Medicine, Mayo Clinic Arizona, 13400 East Shea Boulevard, Scottsdale, AZ, 85259, USA. Ibrahim.ramzi@mayo.edu. * 5 Department of Cardiovascular Medicine, University of Arizona, Phoenix, AZ, USA. # Contributed equally. * PMID: **42827168** * DOI: [ 10.1007/s11886-026-02426-9 ](https://doi.org/10.1007/s11886-026-02426-9) Item in Clipboard Cite Display options Display options Format Abstract PubMed PMID Linked Discoveries ## Abstract **Purpose of review:** Metabolic dysfunction-associated steatotic liver disease (MASLD) is a prevalent chronic liver disease and a multisystem cardiometabolic disorder. Cardiovascular disease (CVD) is a major cause of morbidity and mortality in this population. This review examines disparities in the recognition and management of coexisting cardiovascular and metabolic liver disease. **Recent findings:** Shared metabolic and inflammatory pathways link liver disease with obesity, type 2 diabetes, hypertension, and CVD. Differences in measured disease prevalence across racial and ethnic groups must be interpreted separately from genetic susceptibility and in the context of structural inequities, diagnostic practices, and access to care. Socioeconomic disadvantage and sex- and gender-related barriers may further affect diagnosis and treatment. Resmetirom and semaglutide have expanded treatment options for selected adults with metabolic dysfunction-associated steatohepatitis (MASH), but unequal access to fibrosis assessment, insurance coverage, and longitudinal care may limit their benefits. An equity-centered cardio-hepatology framework should integrate early risk identification, stepwise noninvasive fibrosis assessment, individualized cardiovascular prevention, and access to indicated liver-directed therapies. Treatment and quality measures should reflect clinical eligibility rather than medication use alone. Inclusive research and coordinated long-term care are needed to evaluate whether these strategies narrow disparities. **Keywords:** Cardio-hepatology; Cardiovascular disease; Diabetes; Health disparities; Metabolic dysfunction–associated steatohepatitis; Metabolic dysfunction–associated steatotic liver disease; Obesity; Resmetirom; Semaglutide. © 2026. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature. [PubMed Disclaimer](https://pubmed.ncbi.nlm.nih.gov/disclaimer/) ## Conflict of interest statement Declarations. Conflict of Interest: Chadi Ayoub reports a stipend received as Section Editor from Circulation: Cardiovascular Imaging, outside the submitted work. The remaining authors have nothing to disclose. Human and Animal Rights and Informed Consent: This article does not contain any studies with human or animal subjects performed by any of the authors. ## References 1. 1. European Association for the Study of the Liver (EASL), European Association for the Study of Diabetes (EASD). European Association for the Study of Obesity (EASO). EASL-EASD-EASO Clinical Practice Guidelines on the management of metabolic dysfunction-associated steatotic liver disease (MASLD). J Hepatol. 2024;81:492–542. . - [DOI](https://doi.org/10.1016/j.jhep.2024.04.031) 2. 1. Rinella ME, Neuschwander-Tetri BA, Siddiqui MS, Abdelmalek MF, Caldwell S, Barb D, et al. AASLD Practice Guidance on the clinical assessment and management of nonalcoholic fatty liver disease. Hepatology. 2023;77:1797–835. . - [DOI](https://doi.org/10.1097/hep.0000000000000323) - [PubMed](https://pubmed.ncbi.nlm.nih.gov/36727674/) - [PMC](https://pmc.ncbi.nlm.nih.gov/articles/10735173/) 3. 1. Ekstedt M, Hagström H, Nasr P, Fredrikson M, Stål P, Kechagias S, et al. Fibrosis stage is the strongest predictor for disease-specific mortality in NAFLD after up to 33 years of follow‐up. Hepatology. 2015;61:1547–54. . - [DOI](https://doi.org/10.1002/hep.27368) - [PubMed](https://pubmed.ncbi.nlm.nih.gov/25125077/) 4. 1. Duell PB, Welty FK, Miller M, Chait A, Hammond G, Ahmad Z, et al. Nonalcoholic Fatty Liver Disease and Cardiovascular Risk: A Scientific Statement From the American Heart Association. Arterioscler Thromb Vasc Biol. 2022;42:e168–85. . - [DOI](https://doi.org/10.1161/atv.00000000
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