{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,9]],"date-time":"2026-11-09T16:50:24Z","timestamp":1794243024004,"version":"4.9.0"},"reference-count":100,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"1","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Circulation"],"published-print":{"date-parts":[[2025,1,7]]},"abstract":"<jats:p>There is a new awareness of the widespread nature of metabolic dysfunction\u2013associated steatotic liver disease (MASLD) and its connection to cardiovascular disease (CVD). This has catalyzed collaboration between cardiologists, hepatologists, endocrinologists, and the wider multidisciplinary team to address the need for earlier identification of those with MASLD who are at increased risk for CVD. The overlap in the pathophysiologic processes and parallel prevalence of CVD, metabolic syndrome, and MASLD highlight the multisystem consequences of poor cardiovascular\u2013liver\u2013metabolic health. Metabolic dysfunction and associated insulin resistance, together with the predilection for ectopic fat deposition in the liver and surrounding tissues, are associated with elevated risk of endothelial dysfunction, systemic inflammatory response, and ectopic fat deposition in the epicardium. This complex pathophysiology can accelerate atherogenic dyslipidemia, atherogenesis, diastolic dysfunction, valvular calcification, and cardiac arrhythmias. Despite the mounting evidence of mechanistic pathways underpinning MASLD and CVD, current recommendations have not clearly focused upon MASLD as a risk factor or target for intervention in CVD. We have brought together a diverse range of international experts committed to promoting cardiovascular\u2013liver\u2013metabolic health and related outcomes across the globe. The overarching goal of this document is to offer a construct for clinicians in the cardiovascular field with regards to (1) diagnosis and screening of MASLD through the use of noninvasive serum and imaging tests; (2) screening for CVD in all individuals with MASLD regardless of established atherosclerotic risk factors; and (3) the approach to management of MASLD with respect to prevention of CVD through lifestyle, as well as pharmacologic and surgical strategies. To achieve this, the modified Delphi method was applied and a series of evidence-based quality standard recommendations have been identified.<\/jats:p>","DOI":"10.1161\/circulationaha.124.070535","type":"journal-article","created":{"date-parts":[[2024,12,26]],"date-time":"2024-12-26T19:00:27Z","timestamp":1735239627000},"page":"98-119","update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":195,"title":["Cardiovascular-Liver-Metabolic Health: Recommendations in Screening, Diagnosis, and Management of Metabolic Dysfunction-Associated Steatotic Liver Disease in Cardiovascular Disease via Modified Delphi Approach"],"prefix":"10.1161","volume":"151","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0640-0430","authenticated-orcid":true,"given":"Nicholas W.S.","family":"Chew","sequence":"first","affiliation":[{"name":"Department of Cardiology, National University Heart Centre (N.W.S.C., A.Z., R.F., M.Y.C.), National University Health System, Singapore."},{"name":"Yong Loo Lin School of Medicine (N.S.W.C., R.G., Y.C., B.C., D.Q.H., R.F., M.Y.C., M.M., D.J.H.), National University of Singapore, Singapore."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6910-5551","authenticated-orcid":true,"given":"Anurag","family":"Mehta","sequence":"additional","affiliation":[{"name":"Virginia Commonwealth University Health Pauley Heart Center, Division of Cardiology (A.M.), Department of Internal Medicine, Virginia Commonwealth University School of Medicine, Richmond."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rachel Sze Jen","family":"Goh","sequence":"additional","affiliation":[{"name":"Yong Loo Lin School of Medicine (N.S.W.C., R.G., Y.C., B.C., D.Q.H., R.F., M.Y.C., M.M., D.J.H.), National University of Singapore, Singapore."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5201-0038","authenticated-orcid":true,"given":"Audrey","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Cardiology, National University Heart Centre (N.W.S.C., A.Z., R.F., M.Y.C.), National University Health System, Singapore."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yiming","family":"Chen","sequence":"additional","affiliation":[{"name":"Yong Loo Lin School of Medicine (N.S.W.C., R.G., Y.C., B.C., D.Q.H., R.F., M.Y.C., M.M., D.J.H.), National University of Singapore, Singapore."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3565-7657","authenticated-orcid":true,"given":"Bryan","family":"Chong","sequence":"additional","affiliation":[{"name":"Yong Loo Lin School of Medicine (N.S.W.C., R.G., Y.C., B.C., D.Q.H., R.F., M.Y.C., M.M., D.J.H.), National University of Singapore, Singapore."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Han Shi Jocelyn","family":"Chew","sequence":"additional","affiliation":[{"name":"Alice Lee Centre for Nursing Studies (J.C.), National University of Singapore, Singapore."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Asim","family":"Shabbir","sequence":"additional","affiliation":[{"name":"National University of Singapore, Department of Surgery (A.Shabbir), National University Hospital, Singapore."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1818-6192","authenticated-orcid":true,"given":"Adrian","family":"Brown","sequence":"additional","affiliation":[{"name":"University College London Centre for Obesity Research; 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