Golden Liver Health Forum: Multidisciplinary Approaches to Cardiometabolic and Liver Disease Management
27 Dec 2024
The Golden Liver Health Forum, convened on October 24, 2024, at the Globe Auditorium in BGC, presented evolving multi-disciplinary strategies in managing Metabolic Associated Fatty Liver Disease (MAFLD). Through insightful discussions from top experts in endocrinology, cardiology, and hepatology—Bien Matawaran, MD, Louella Santos, MD, and Stephen Wong, MD, chaired by Prof Jose D. Sollano Jr., MD, the forum provided clinicians with valuable, patient-centered strategies that enhance risk assessment and management for these intertwined health concerns.
Opening the session, Prof Jose D. Sollano Jr., MD presented a compelling case study involving a 45-year-old call center manager, diagnosed with fatty liver and metabolic irregularities. His presentation underscored the importance of a personalized, patient-centered approach in managing MAFLD, which affects a growing number of individuals with sedentary lifestyles, high-stress jobs, and irregular work hours.
Risk Stratification and Individualized Treatment
Dr Matawaran emphasized that effective management of MAFLD begins with accurate risk stratification tailored to each patient’s unique metabolic profile. The first step involves a comprehensive screening process, examining body mass index (BMI), fasting blood sugar, HbA1c, blood pressure, and lipid profile markers.1 “No two patients are alike,” Dr. Matawaran noted, stressing that a personalized approach is essential for optimizing outcomes and preventing disease progression.
Dr Wong referenced the latest guidelines from the European Association for the Study of the Liver (EASL), prioritizing non-invasive methods for assessing liver health. Tests such as the Fibrosis-4 (FIB-4) index, the NAFLD fibrosis score (NFS), aspartate aminotransferase to platelet ratio index (APRI), and liver elastography provide essential information about fibrosis risk.2 These assessments are crucial for identifying patients at high risk of progressing to severe liver conditions like cirrhosis or MAFLD, and they allow clinicians to offer preventive care and lifestyle interventions before irreversible damage occurs. This patient-centered methodology exemplifies the meaningful approach to managing MAFLD within a cardiometabolic framework.
The Bidirectional Relationship Between MAFLD and Cardiovascular Disease
Cardiologist Dr Louella Santos followed with an insightful discussion on the links between MAFLD and cardiovascular disease, a relationship that is not only complex but also bidirectional. Studies have shown that patients with MAFLD face a higher risk of experiencing adverse cardiovascular events, including heart attacks and strokes.3 “MAFLD doesn’t just impact liver health; it has systemic implications that significantly elevate cardiovascular risk,” Dr Santos emphasized.
Cardiovascular Risk Screening in MAFLD Patients
Dr Santos presented a proactive strategy for cardiovascular risk screening in patients with MAFLD. This includes evaluating lipid profiles, smoking history, and age, with particular attention to patients over 45 years old. Elevated LDL cholesterol levels, specifically above 130 mg/dL, were highlighted as a key risk factor. Dr Santos emphasized that addressing MAFLD in tandem with cardiovascular concerns is essential to optimizing patient outcomes and preventing fatal cardiovascular events.
A comprehensive treatment plan that tackles both MAFLD and its cardiovascular implications is pivotal. According to Dr Santos, this should include lifestyle modifications and lipid management strategies alongside regular screening. Addressing MAFLD can substantially reduce cardiovascular morbidity and mortality, underscoring the importance of interdisciplinary care that combines hepatologic and cardiologic expertise. “Patients benefit most when we adopt a holistic approach, viewing their health as an interconnected system rather than isolated organs,” Dr Santos noted.
NAFLD Complexity: Expanding the Scope of Patient Care
Hepatologist Dr Stephen Wong addressed the complex dynamics of nonalcoholic fatty liver disease (NAFLD) and its interplay with metabolic disorders. He explained that NAFLD, MAFLD, and MASLD, though categorized as liver diseases, are markers of systemic health issues linked with metabolic syndrome. This condition is characterized by obesity, dyslipidemia, and insulin resistance, often leading to a cascade of complications beyond liver health alone.
Routine liver ultrasound findings that reveal fatty liver should prompt clinicians to consider the patient’s broader metabolic status, Dr Wong recommended. When fatty liver is detected, it may be an early warning sign of underlying metabolic syndrome, which places patients at increased risk for cardiovascular disease, Type 2 diabetes, and other co-morbidities. Dr Wong stressed the need for routine screening of glucose levels, cholesterol, and blood pressure, along with dietary and lifestyle counseling to address the broader implications of MAFLD.
Effective MAFLD management, according to Dr Wong, involves proactive lifestyle and dietary interventions to reduce the risk of comorbidities. By encouraging patients to adopt healthier lifestyles, clinicians can mitigate risk factors like obesity and insulin resistance, thereby reducing the likelihood of disease progression. "The path to improved liver health often lies in preventive measures that address metabolic dysfunction at its root," Dr Wong observed, advocating for a multidisciplinary approach to MAFLD care.
Multidisciplinary Care for Systemic Health Risks
The speakers at the Golden Liver Health Forum collectively highlighted that NAFLD, MAFLD, and MASLD are not isolated conditions but indicators of systemic health issues. Their management requires a multidisciplinary approach involving hepatologists, endocrinologists, and cardiologists, ensuring comprehensive patient care that goes beyond liver-specific interventions.
According to Prof Sollano, who led the forum, the complexity of these diseases calls for collaboration among various medical fields to offer patients a more holistic approach to health. Through early detection, personalized treatment, and proactive management of not just lifestyle factors but also psychosocial stressors, clinicians can better address the root causes of these interlinked conditions and reduce the risk of long-term complications.
Key Takeaways from the Golden Liver Health Forum
The forum provided numerous takeaways for healthcare providers managing patients with MAFLD and related cardiometabolic diseases:
- Patient-Centered Approach: Tailoring care to the individual’s metabolic profile is essential for effective MAFLD management, as shown in the case study.
- Risk Identification: Non-invasive tests recommended by EASL, such as FIB-4 and elastography, allow for early identification of fibrosis, facilitating timely interventions.
- Bidirectional Impact of MAFLD on Cardiovascular Health: Dr Santos’ insights reinforced the need for cardiologists to screen MAFLD patients for cardiovascular risks and adopt a preventive approach.
- Holistic Health Assessment: Dr Wong emphasized that routine ultrasound findings of fatty liver should prompt broader metabolic screenings, integrating dietary and lifestyle changes into the treatment plan.
- Multidisciplinary Collaboration: Effective MAFLD management necessitates collaboration across specialties, promoting a system-wide approach that optimizes patient outcomes.
The Golden Liver Health Forum highlighted the need for an interdisciplinary approach to managing MAFLD within the broader context of cardiometabolic health. By addressing the interconnections between liver health, metabolic syndrome, and cardiovascular disease, clinicians can offer more comprehensive care and ultimately improve patient outcomes.