There is little awareness among cardiologists regarding the contribution of fatty liver to cardiovascular (CVD) risk. Debates surrounding the importance of screening for fatty liver disease compared to other recognized cardiometabolic risk factors are ongoing.
The term metabolic dysfunction-associated fatty liver disease (MAFLD) has recently been suggested as an alternative to non-alcoholic fatty liver disease (NAFLD). Unlike NAFLD, MAFLD’s diagnosis is based on the active identification of NAFLD-associated metabolic abnormalities, and its definition recognizes coexisting CV risk factors. As such, the proposed transition from NAFLD to MAFLD has important clinical ramifications: it has the power to affect how clinicians, and especially cardiologists, view the association between fatty liver disease and CVD.
This article examines the new MAFLD definition and its relevance for cardiologists.
Patients with MAFLD are at a greater risk of nonfatal CVD events than those with NAFLD. This increased risk could originate from MAFLD’s definition: its diagnosis requires the presence of obesity, type 2 diabetes mellitus, or other features of the metabolic syndrome. All these characteristics are linked with increased CVD risk. Alternatively, MAFLD’s association with increased CVD risk may stem from other coexisting liver diseases, which are not excluded during its diagnosis.
Furthermore, while MAFLD is reportedly associated with a higher risk of all-cause and CVD mortality compared to NAFLD, this association is attenuated following adjustment for cardiometabolic risk factors. As such, MAFLD’s exact role in CVD remains unclear, and should be examined by future research.
Lastly, no pharmacologic therapy has yet been approved for the treatment of NAFLD or MAFLD. However, one point remains clear: once these therapies become licensed, cardiologists and other physicians will need to work in tandem to treat MAFLD.