Lancet Gastroenterology & Hepatology最新文献

英文中文

Pharmacotherapy for metabolic dysfunction-associated steatohepatitis: heart-liver co-management. 代谢功能障碍相关脂肪性肝炎的药物治疗：心-肝联合治疗。

IF 38.6 1区医学 Q1 GASTROENTEROLOGY & HEPATOLOGY

Lancet Gastroenterology & Hepatology

Pub Date : 2026-02-13 DOI: 10.1016/S2468-1253(25)00323-1

Xiao-Dong Zhou, Jeffrey V Lazarus, Chayakrit Krittanawong, Giovanni Targher, Christopher D Byrne, Zobair M Younossi, Frank Tacke, Qin-Fen Chen, Christos S Mantzoros, Herbert Tilg, Wajahat Z Mehal, Laurence S Sperling, Gregory Y H Lip, Norbert Stefan, Ming-Hua Zheng

Metabolic dysfunction-associated steatotic liver disease (MASLD) affects approximately 30% of adults, with about 30% of cases progressing to metabolic dysfunction-associated steatohepatitis (MASH), which can lead to cirrhosis and hepatocellular carcinoma. Cardiovascular disease is the leading cause of death in patients with MASH, highlighting the need for integrated heart-liver co-management. MASLD and cardiovascular disease share common pathophysiological mechanisms, including insulin resistance, low-grade inflammation, atherogenic dyslipidaemia, and oxidative stress, creating a bidirectional interplay that drives disease progression. Effective management of MASLD requires addressing not only hepatic steatosis, inflammation, and fibrosis, but also managing cardiovascular risk. Current clinical practice and trials face several challenges, including the underdiagnosis of MASLD, poor collaboration between hepatologists and cardiologists, and a paucity of pharmacological options that safely target both the liver and heart. This Review covers three main pharmacological approaches: metabolic-targeted therapies, which improve the upstream metabolic milieu; liver-targeted therapies, which focus on MASH and fibrosis, but require further evaluation for cardiovascular safety; and cardiovascular therapies, which might provide hepatoprotective effects, but need further study. This Review discusses the benefits and limitations of these pharmacotherapies, emphasising the importance of an integrated heart-liver co-management approach to improve clinical outcomes for patients living with MASLD.

代谢功能障碍相关脂肪性肝病（MASLD）影响约30%的成年人，其中约30%的病例进展为代谢功能障碍相关脂肪性肝炎（MASH），可导致肝硬化和肝细胞癌。心血管疾病是MASH患者死亡的主要原因，强调了综合心肝联合治疗的必要性。MASLD和心血管疾病具有共同的病理生理机制，包括胰岛素抵抗、低度炎症、动脉粥样硬化性血脂异常和氧化应激，形成了驱动疾病进展的双向相互作用。MASLD的有效管理不仅需要解决肝脂肪变性、炎症和纤维化问题，还需要控制心血管风险。目前的临床实践和试验面临着一些挑战，包括MASLD的诊断不足，肝病学家和心脏病学家之间的合作不足，以及缺乏安全靶向肝脏和心脏的药物选择。本文综述了三种主要的药理学方法：代谢靶向治疗，改善上游代谢环境；肝靶向治疗，侧重于MASH和纤维化，但需要进一步评估心血管安全性；心血管治疗，可能提供肝脏保护作用，但需要进一步研究。本综述讨论了这些药物治疗的益处和局限性，强调了心肝联合治疗对改善MASLD患者临床预后的重要性。

{"title":"Pharmacotherapy for metabolic dysfunction-associated steatohepatitis: heart-liver co-management.","authors":"Xiao-Dong Zhou, Jeffrey V Lazarus, Chayakrit Krittanawong, Giovanni Targher, Christopher D Byrne, Zobair M Younossi, Frank Tacke, Qin-Fen Chen, Christos S Mantzoros, Herbert Tilg, Wajahat Z Mehal, Laurence S Sperling, Gregory Y H Lip, Norbert Stefan, Ming-Hua Zheng","doi":"10.1016/S2468-1253(25)00323-1","DOIUrl":"https://doi.org/10.1016/S2468-1253(25)00323-1","url":null,"abstract":"<p><p>Metabolic dysfunction-associated steatotic liver disease (MASLD) affects approximately 30% of adults, with about 30% of cases progressing to metabolic dysfunction-associated steatohepatitis (MASH), which can lead to cirrhosis and hepatocellular carcinoma. Cardiovascular disease is the leading cause of death in patients with MASH, highlighting the need for integrated heart-liver co-management. MASLD and cardiovascular disease share common pathophysiological mechanisms, including insulin resistance, low-grade inflammation, atherogenic dyslipidaemia, and oxidative stress, creating a bidirectional interplay that drives disease progression. Effective management of MASLD requires addressing not only hepatic steatosis, inflammation, and fibrosis, but also managing cardiovascular risk. Current clinical practice and trials face several challenges, including the underdiagnosis of MASLD, poor collaboration between hepatologists and cardiologists, and a paucity of pharmacological options that safely target both the liver and heart. This Review covers three main pharmacological approaches: metabolic-targeted therapies, which improve the upstream metabolic milieu; liver-targeted therapies, which focus on MASH and fibrosis, but require further evaluation for cardiovascular safety; and cardiovascular therapies, which might provide hepatoprotective effects, but need further study. This Review discusses the benefits and limitations of these pharmacotherapies, emphasising the importance of an integrated heart-liver co-management approach to improve clinical outcomes for patients living with MASLD.</p>","PeriodicalId":56028,"journal":{"name":"Lancet Gastroenterology & Hepatology","volume":" ","pages":""},"PeriodicalIF":38.6,"publicationDate":"2026-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146208384","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}