Helping your patients with MASH begins with understanding the risks
mash: a chronic disease
MASH is a chronic disease projected to affect ~27 million people in the US by 2030.1 If left untreated, it can lead to serious and potentially life-threatening health complications.2,3
Patients with MASLD were 77% more likely to have a CV event than those without the condition4,a
Approximately 20% of patients with MASH and fibrosis stage F3 will progress to cirrhosis over 2 years5
After progression to MASH cirrhosis, cumulative annual incidence rate for developing HCC is up to ~13%6
By 2030, MASH is projected to be the #1 cause of liver transplants among adults in the United States2
aA systematic review and meta-analysis which included 6 prospective cohort studies with a total of 25,837 adults (5,953 with MASLD and 19,884 without). Clinical cardiovascular events were defined as myocardial infarction or angina, stroke/transient ischemic attack (cerebral hemorrhage was excluded), cardiovascular death, need for coronary or peripheral revascularization, symptomatic peripheral vascular disease, clinically driven angiography demonstrating >50% stenosis of epicardial coronaries, and composite of aforementioned endpoints. Median follow-up ranged from 20 months to 18 years. In the MASLD group, there were a total of 887 CV events (14.9%), and in the non-MASLD group, there were a total of 1251 CV events (6.3%).4
After the development of clinically significant fibrosis (F2), the risk of liver-related mortality significantly increased and continued to grow with further fibrosis progression.3,b
bA meta-analysis which included 5 cohort studies (retrospective or prospective) with a total of 1,495 adults with MASLD and 17,452 patient years of follow-up. Patients were stratified by fibrosis stage (F0–F4) to evaluate the risk of all-cause and liver-related mortality associated with each fibrosis stage. Statistically significant increased risk of liver-related mortality in those with fibrosis (F2-F4) was based on comparison with patients with no fibrosis (F0). The liver-related mortality rate was 4.28 per 1000 patient years of follow-up (PYF) for F2, 7.92 per 1000 PYF for F3, and 23.3 per 1000 PYF for F4, compared to 0.30 per 1000 PYF for F0.3
cExamples of patient populations who may be at risk—not all-inclusive of groups who should be screened for MASH.7
References
- Estes C, Anstee QM, Arias-Loste MT, et al. Modeling NAFLD disease burden in China, France, Germany, Italy, Japan, Spain, United Kingdom, and United States for the period 2016-2030. J Hepatol. 2018;69(4):896-904. doi:10.1016/j.jhep.2018.05.036
- Westfall E, Jeske R, Bader AR. Nonalcoholic fatty liver disease: common questions and answers on diagnosis and management. Am Fam Physician. 2020;102(10):603-612.
- Dulai PS, Singh S, Patel J, et al. Increased risk of mortality by fibrosis stage in nonalcoholic fatty liver disease: systematic review and meta-analysis. Hepatol. 2017;65(5):1557-1565. doi:10.1002/hep.29085
- Mahfood Haddad T, Hamdeh S, Kanmanthareddy A, Alla VM. Nonalcoholic fatty liver disease and the risk of clinical cardiovascular events: a systematic review and meta-analysis. Diabetes Metab Syndr. 2017;11 (Suppl 1):S209-S216.
- Loomba R, Adams LA. The 20% rule of NASH progression: the natural history of advanced fibrosis and cirrhosis caused by NASH. Hepatol. 2019;70(6):1885-1888. doi:10.1002/hep.30946
- Cholankeril G, Patel R, Khurana S, Satapathy SK. Hepatocellular carcinoma in nonalcoholic steatohepatitis: current knowledge and implications for management. World J Hepatol. 2017;9(11):533-543. doi:10.4254/wjh.v9.i11.533
- Cusi K, Isaacs S, Barb D, et al. American Association of Clinical Endocrinology clinical practice guideline for the diagnosis and management of nonalcoholic fatty liver disease in primary care and endocrinology clinical settings: co-sponsored by the American Association for the Study of Liver Diseases (AASLD). Endocr Pract. 2022;28(5):528-562. doi:10.1016/j.eprac.2022.03.010
- Quek J, Chan KE, Wong ZY, et al. Global prevalence of non-alcoholic fatty liver disease and non-alcoholic steatohepatitis in the overweight and obese population: a systematic review and meta-analysis. Lancet Gastroenterol Hepatol. 2023;8(1):20-30. doi:10.1016/S2468- 1253(22)00317-X
- Younossi ZM, Golabi P, de Avila L, et al. The global epidemiology of NAFLD and NASH in patients with type 2 diabetes: a systematic review and meta-analysis. J Hepatol. 2019;71(4):793-801. doi:10.1016/j.jhep.2019.06.021