Heart-liver co-management in MASLD: expert perspectives and recommendations from a multidisciplinary cardiometabolic framework.

Metabolic dysfunction-associated steatotic liver disease (MASLD) is recognized as a systemic metabolic disorder with marked cardiovascular implications, as cardiovascular disease is a leading cause of death. Despite non-invasive diagnostic tests, such as the fibrosis-4 index and vibration-controlled transient elastography, and the availability of resmetirom and emerging pharmacotherapies with dual liver and cardiovascular benefits (for example, glucagon-like peptide 1 receptor agonists and sodium-glucose cotransporter 2 inhibitors), substantial gaps in coordinated clinical management remain. MASLD is often under-recognized in cardiology, and the cardiovascular risk associated with MASLD is similarly under-appreciated in hepatology practice, resulting in fragmented care and a lack of integrated management pathways. This discrepancy leads to missed opportunities for early intervention and suboptimal outcomes in the progression of both hepatic and cardiovascular diseases. To address these gaps, a more collaborative, multidisciplinary approach is needed, integrating early screening, risk stratification and coordinated management across specialities. In this Expert Recommendation, we outline key considerations for heart-liver co-management in MASLD, propose practical strategies for screening and risk stratification, and discuss pathways to implement coordinated multidisciplinary care in clinical practice within a structured metabolic care framework.