Heart Health and Metabolic Dysfunction-Associated Steatohepatitis
Health ConditionsLiver Disease

The Link Between Your Heart Health and MASH

Learn how certain heart and liver conditions are connected — and what you can do to protect your health.
The Link Between Your Heart Health and MASH
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Published on January 31, 2025
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If you have heart issues, such as high blood pressure or high cholesterol, taking steps to manage them helps keep your heart health in check. But it also helps prevent comorbidities (other conditions you have at the same time), including liver issues such as metabolic dysfunction–associated steatohepatitis (MASH).

MASH (formerly known as nonalcoholic steatohepatitis) occurs when there’s a buildup of fat in the liver. Left untreated, MASH can damage the liver and lead to cirrhosis, fibrosis (scarring), liver cancer, or liver failure. A liver transplant may be required in certain cases where advanced liver disease has developed.

Keep reading to learn how MASH is related to heart health, plus how to keep your heart and liver healthy.

Your Heart, Metabolic Health, and MASH

“MASH is not an isolated liver disease. It’s linked to other components of metabolic syndrome,” says Arun Sanyal, MD, director of the Stravitz-Sanyal Institute for Liver Disease and Metabolic Health at Virginia Commonwealth University in Richmond.

Metabolic syndrome is a group of conditions that increase your risk of developing diabetes, heart disease, and stroke. You may be diagnosed with metabolic syndrome if you have three or more of the following:

  • Abdominal obesity
  • High blood pressure
  • High blood sugar
  • High triglycerides
  • Low HDL (“good”) cholesterol

There’s a bidirectional relationship between metabolic syndrome and MASH. “If you have fat in your liver, you’re more likely to develop other features of metabolic syndrome. And the more features of metabolic syndrome you have, the more likely you are to have fat in your liver and a more aggressive form of fatty liver disease,” Dr. Sanyal explains.

Other Risk Factors for MASH

Along with metabolic syndrome, additional factors can increase your risk of developing MASH, including:

  • Having other health conditions, such as an underactive thyroid or polycystic ovary syndrome
  • Being over age 40
  • Being Latino or Asian
  • Being postmenopausal
  • Having a protein deficiency
  • Experiencing rapid weight loss

Why Routine Testing Is Important

Most people who have MASH don’t experience any symptoms.

 “The liver won’t tell you what’s going on until things are very advanced,” says Sanyal. “This disease can progress silently until it reaches cirrhosis.”

That’s where routine screenings come in. Sanyal recommends seeing your doctor for an annual visit to discuss your overall health. At each appointment, be sure to:

  • Go over your family history. If you have a strong family history of metabolic disorder, there’s a higher likelihood that you have fat in your liver, says Sanyal. First-degree relatives of people with MASH should be screened, according to recent guidance from the American Association for the Study of Liver Diseases.

  • Be screened for metabolic syndrome. You should have your blood pressure checked and ask about a blood test to check your blood sugar, cholesterol, and triglycerides. Taking a waist measurement can be used to track abdominal obesity.
  • Have a liver function test. This checks on the health of your liver.
  • Ask about your FIB-4 score. This fibrosis index score can be computed from several data points, including your age and liver enzymes. The outcome is an indication of your risk of liver-related problems, says Sanyal. If your score shows you are high risk, your doctor will refer you to a gastroenterologist or liver specialist for possible further testing.
If your doctor suspects you have MASH, they may recommend imaging tests, such as a CT scan, MRI, or ultrasound, to check for inflammation and scarring. A liver biopsy may be needed to confirm a MASH diagnosis and determine the extent of liver damage. But recent advances in the accuracy of noninvasive blood and imaging tests have reduced the need for biopsies.

How to Manage Your Heart Health and Reduce Your Risk of MASH

When it comes to preventing MASH, “The focus is improving your metabolic health and treating obesity,” says Sanyal. That involves making lifestyle changes such as:

  • Following a heart-healthy diet
  • Exercising regularly
  • Taking other steps to reach and maintain a healthy weight
  • Managing stress
  • Prioritizing sleep
  • Quitting smoking
  • Drinking coffee
These lifestyle changes are also central to diabetes management. Because data shows that diabetes is a driver of MASH, improving insulin function and regulating your blood sugar will also aid in long-term liver health.

Weight loss and diabetes medications such as GLP-1s (e.g., semaglutide) and GLP-1/GIPs (e.g., tirzepatide) are also increasingly being considered as a potential treatment for MASH.

 “These medications target the background of obesity and the metabolic state, and they’ve also been shown to have a cardiovascular, kidney, and liver benefit,” Sanyal says.
If you’re diagnosed with MASH, your doctor may also prescribe a drug called resmetirom (Rezdiffra), which is the only drug that’s been approved by the U.S. Food and Drug Administration for treating MASH with moderate-to-advanced liver scarring.

The Takeaway

  • Metabolic dysfunction–associated steatohepatitis (MASH) is a progressive, severe form of liver disease that increases the risk of cirrhosis and liver failure.
  • Metabolic syndrome, which involves a cluster of conditions, such as high blood pressure and cholesterol, is linked to an accumulation of liver fat. And excess liver fat also makes metabolic syndrome worse.
  • Following healthy lifestyle habits, such as eating a heart-healthy diet and exercising regularly, can help improve heart and liver health. Certain medications are available to treat obesity and diabetes, which may also benefit the liver.
Meet Our Experts
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Jonathan G. Stine, MD, MSc, FACP

Medical Reviewer
Castle Connolly Top Doctor

Jonathan Stine, MD, MSc, FACP, is an associate professor of medicine and public health science at Penn State in State College, Pennsylvania.

As an internationally recognized liver expert with a research and clinical focus on metabolic dysfunction–associated steatotic liver disease (MASLD) and exercise, he has authored more than 100 peer-reviewed papers, including multinational consensus guidelines.

Dr. Stine is the recipient of multiple research grants and awards from the American Association for the Study of Liver Diseases and the American Cancer Society, and has maintained continuous funding from the National Institutes of Health since 2018.

Stine is the MASLD consultant to the American College of Sports Medicine’s “Exercise is Medicine” initiative, and recently co-chaired the International Roundtable on MASLD and Physical Activity for ACSM. He serves as the Fatty Liver Program director as well as the Liver Center Research director for Penn State.

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Jessica Migala

Author

Jessica Migala is a freelance writer with over 15 years of experience, specializing in health, nutrition, fitness, and beauty. She has written extensively about vision care, diabetes, dermatology, gastrointestinal health, cardiovascular health, cancer, pregnancy, and gynecology. She was previously an assistant editor at Prevention where she wrote monthly science-based beauty news items and feature stories.

She has contributed to more than 40 print and digital publications, including Cosmopolitan, O:The Oprah Magazine, Real Simple, Woman’s Day, Women’s Health, Fitness, Family Circle, Health, Prevention, Self, VICE, and more. Migala lives in the Chicago suburbs with her husband, two young boys, rescue beagle, and 15 fish. When not reporting, she likes running, bike rides, and a glass of wine (in moderation, of course).

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Everyday Health follows strict sourcing guidelines to ensure the accuracy of its content, outlined in our editorial policy. We use only trustworthy sources, including peer-reviewed studies, board-certified medical experts, patients with lived experience, and information from top institutions.
Resources
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