Cardiovascular Disease in Nonalcoholic Steatohepatitis: Screening and Management
- PDF / 671,277 Bytes
- 12 Pages / 595.276 x 790.866 pts Page_size
- 66 Downloads / 183 Views
FATTY LIVER DISEASE (V AJMERA, SECTION EDITOR)
Cardiovascular Disease in Nonalcoholic Steatohepatitis: Screening and Management Hersh Shroff 1 & Lisa B. VanWagner 1,2
# Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose of Review The global burden of nonalcoholic steatohepatitis (NASH) as a major cause of chronic liver disease continues to rise. Cardiovascular disease (CVD) is a leading cause of morbidity and mortality in this patient population. The current review summarizes recent advances in the understanding of CVD in NASH and strategies for screening and management. Recent Findings Large genetic epidemiological studies support the intricate role of the metabolic syndrome in the pathophysiology of CVD risk in patients with NASH. Atherosclerotic CVD risk scores can predict elevated CV risk in NASH, but additional work is necessary to refine risk stratification and to guide optimal management. New antidiabetic agents may offer benefit in treating steatosis and reducing CV morbidity in NASH. Summary Achieving improved outcomes in patients with NASH requires that future efforts focus on optimizing methods for CVD screening and designing clinical trials with long-term cardiovascular endpoints in mind. Keywords Nonalcoholic fatty liver disease . Nonalcoholic steatohepatitis . Cirrhosis . Cardiovascular disease . Atherosclerosis
Introduction Nonalcoholic fatty liver disease (NAFLD) is a chronic condition that is intricately associated with the metabolic syndrome. Mirroring the rising global burden of obesity, NAFLD is rapidly becoming one of the most common etiologies of chronic liver disease, affecting one out of every four individuals worldwide [1, 2]. Nonalcoholic steatohepatitis (NASH), a subtype of NAFLD characterized by inflammation and hepatocyte injury, can ultimately lead to cirrhosis and hepatocellular carcinoma and is now the second most common indication for liver transplantation (LT) in the USA [3, 4]. However, cardiovascular disease (CVD), rather than liver decompensation, remains the leading cause of morbidity and mortality in patients with NAFLD and NASH [5••]. While a significant This article is part of the Topical Collection on Fatty Liver Disease * Lisa B. VanWagner [email protected] 1
Division of Gastroenterology and Hepatology, Department of Medicine, Northwestern University Feinberg School of Medicine, 676 N. St Clair St, Suite 1400, Chicago, IL 60611, USA
2
Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
proportion of the cardiovascular risk in NASH is likely attributable to shared metabolic risk factors, there is much interest in understanding the independent contribution of hepatic steatosis and associated inflammation and fibrosis. Extensive research documents a high prevalence of various subclinical and clinical manifestations of atherosclerotic CVD (ASCVD) in NAFLD, and yet there remains an ongoing need for evidence-based guidance on the optimal approach to CVD screening, prevention, and tre
Data Loading...
