The Importance of a Multidisciplinary Approach for NASH and CVD

In this video, Cardiology Consultant Advisory Board Member Seth Baum, MD, talks about the many stakeholders that should be involved in the treatment of a patient with nonalcoholic steatohepatitis and cardiovascular disease. It was a topic he discussed for the ASPC 2020 Virtual Summit on CVD Prevention. 

Seth Baum, MD, is a preventive cardiologist and the immediate past president of the American Society for Preventive Cardiology.

TRANSCRIPT:

Seth Baum: Hello, everyone. My name is Seth Baum. I’m past president of the American Society for Preventive Cardiology. At this year’s annual Congress, I’ve spoken about the intersection between NASH—nonalcoholic steatohepatitis—and cardiovascular disease.

When people have nonalcoholic steatohepatitis, this is affecting not only the liver, but also increases the risk of cardiovascular disease. And in fact, the number one cause of death among patients with nonalcoholic steatohepatitis is not a liver-related death, it’s cardiovascular. And that cardiovascular death seems to be independent of some of the comorbidities that are associated with both NASH and cardiovascular disease, such as diabetes, high triglycerides, central obesity, metabolic syndrome. These are all common to both disorders, but independent of the risks associated with those disorders, independent of that, it seems that steatohepatitis will cause an increase in cardiovascular disease. And it’s not just atherosclerotic, it’s also arrhythmic and myopathic. So there are multiple ways that fatty liver can be a problem. 

It is important to recognize that there are multiple stakeholders in nonalcoholic steatohepatitis. Obviously at the center is the patient, but we also have the hepatologist, we have the cardiologist, we have the endocrinologist, and we have the dietitian or nutritionist. It’s important that we have a team approach to this so we can really attack all of these manifold risk factors that lead to fatty liver and to steatohepatitis.

We should also remember that a biopsy, although not commonly done at this point, is really something to consider in our patients. We should think about doing biopsies or sending patients for biopsy consideration, ie. to hepatologist or gastroenterologist, because the biopsy currently is the gold standard. Again, the FibroScan, the MRI, the MRE are very good tests to evaluate for fatty liver, but the gold standard still remains the biopsy.

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