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Glucagon\u2010like peptide\u20101 receptor agonists (GLP\u20101RAs) are uniquely positioned to address this liver\u2013heart axis by combining hepatic disease\u2010modifying signals with proven cardiovascular risk reduction. This review synthesizes mechanistic, randomized trial, real\u2010world, and cardiovascular outcome evidence for GLP\u20101RAs in MASLD and metabolic dysfunction\u2010associated steatohepatitis (MASH). In biopsy\u2010based trials, liraglutide (LEAN) increased steatohepatitis resolution without fibrosis worsening (39% vs. 9% with placebo), while semaglutide demonstrated dose\u2010dependent resolution (up to 59% vs. 17% in Phase 2). More recently, semaglutide 2.4\u2009mg weekly met both histologic endpoints at interim analysis in F2\u2013F3 MASH (resolution without fibrosis worsening 62.9% vs. 34.3%; fibrosis improvement \u2265\u20091 stage 36.8% vs. 22.4%), and tirzepatide (SYNERGY\u2010NASH) achieved high rates of MASH resolution (44%\u201362% vs. 10%) with concomitant fibrosis improvement signals (up to 51% vs. 30%). Cardiovascular outcome trials demonstrate consistent reductions in major adverse cardiovascular events with GLP\u20101RAs, including liraglutide (LEADER), semaglutide (SUSTAIN\u20106 and SELECT), and dulaglutide (REWIND). Mechanistically, GLP\u20101RAs reduce hepatic lipogenesis and lipotoxicity, attenuate inflammation, improve insulin sensitivity, and modulate gut\u2013brain\u2013liver signaling, with systemic benefits on weight, blood pressure, and atherogenic lipoproteins. Collectively, the evidence supports GLP\u20101RAs, particularly semaglutide and tirzepatide, as foundational therapies for MASLD patients with obesity, type 2 diabetes, advanced fibrosis, or heart failure phenotypes. Key gaps include treatment duration, durability of fibrosis benefit, and effectiveness in cirrhosis, requiring long\u2010term follow\u2010up.<\/jats:p>","DOI":"10.1002\/cdt3.70048","type":"journal-article","created":{"date-parts":[[2026,3,24]],"date-time":"2026-03-24T10:20:21Z","timestamp":1774347621000},"page":"85-99","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["GLP\u20101 Receptor Agonists in Metabolic Dysfunction\u2010Associated Steatotic Liver Disease: Bridging Hepatic and Cardiovascular Outcomes"],"prefix":"10.1002","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0009-0003-0148-6401","authenticated-orcid":false,"given":"Gabriel","family":"Amorim Moreira Alves","sequence":"first","affiliation":[{"name":"Faculty of Medicine and Surgery Humanitas University Pieve Emanuele 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