Addressing Cardiovascular Health in MASH, with Viet Le, DMSc, PA-C

Cardiovascular disease is a leading cause of death in patients with metabolic dysfunction-associated steatotic liver disease (MASLD) and metabolic dysfunction-associated steatohepatitis (MASH). While liver damage is often the clinical focus, the overlapping metabolic risks, including obesity, diabetes, hypertension, and dyslipidemia, drive the threat of heart attacks, strokes, and heart failure.

With MASLD projected to affect more than 40% of US adults by 2050, tackling this dual burden has become a pressing priority in modern hepatology, as discussed by Viet Le, DMSc, PA-C, an associate professor of research and a preventive cardiology PA at Intermountain Health, at the 2025 Gastroenterology & Hepatology Advanced Practice Providers (GHAPP) conference.

Patients with MASLD face heightened risks of coronary artery disease, cerebrovascular events, arrhythmias, and heart failure. Even among those without advanced fibrosis, vascular and metabolic changes can accelerate atherosclerosis and impair cardiac function, making cardiovascular risk assessment an essential part of MASLD and MASH management, not only for patients already presenting with metabolic comorbidities but also for those at earlier stages of liver disease.

“[Multidisciplinary] conversations are growing. It really takes champions, and it takes people who are passionate about patient care to make those conversations, because currently, we're all inundated in healthcare systems,” Le explained to HCPLive.

He says that in order to reduce events and hospitalizations, providers must have conversations with the specialists next door to them. In his preventing cardiology clinic, Le says he has been discussing this with his colleagues in endocrinology, nephrology, and hepatology for years, but they still have not figured out a perfect approach.

Le goes on to reflect on the historical role weight loss has played in MASH management, describing obesity as a chronic disease with adipose pathology leading to liver inflammation and fibrosis.

“Now we have the GLP-1s, and what a fascinating area of a therapeutic molecule that now has dual incretin, they're looking at triple incretin, and that second incretin molecule has been interesting as to who is doing what with it, and what type of incretin they're looking at,” Le explained.

While GLP-1s have historically been known for their role in treating diabetes and facilitating weight loss, Novo Nordisk’s semaglutide (Wegovy) recently became the second FDA-approved MASH treatment.

“I think what it comes back down to is, is it a magic therapeutic molecule that just happens to treat all these things, or is it treating one central theme? And I think that's where we're at, is a better understanding coming back to adiposopathy,” Le said. “I think that’s a tying type of disease, and that's why we're seeing so many positive trials across the CKM space… As we look forward in time, I think we're going to see several more therapies come out through the GLP-1 space.”

References

1. Le P, Tatar M, Dasarathy S, et al. Estimated Burden of Metabolic Dysfunction–Associated Steatotic Liver Disease in US Adults, 2020 to 2050. JAMA Netw Open. 2025;8(1):e2454707. doi:10.1001/jamanetworkopen.2024.54707

2. Brooks A. FDA Approves Semaglutide (Wegovy) Injection 2.4 mg for Noncirrhotic MASH. HCPLive. August 15, 2025. Accessed September 19, 2025. https://www.hcplive.com/view/fda-approves-semaglutide-wegovy-injection-2-4-mg-for-noncirrhotic-mash