Seth Baum, MD, on the Prevalence, Diagnosis, and Management of NASH and CVD

In this video, Cardiology Consultant Advisory Board Member Seth Baum, MD, overviews the intersection between nonalcoholic steatohepatitis and cardiovascular disease, which he calls the "next big threat to our population." 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.



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. This is the next big threat, frankly, to our population.

Currently, 25% of Americans have nonalcoholic fatty liver disease, and about 5% to 7% have nonalcoholic steatohepatitis. So what does that mean? Well, 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. 

I think the important things that we need to know, in addition to the prevalence, that problem, is that there are over 40 different drugs in development right now. There is hopefully going to be some help down the road. But lifestyle changes are very, very effective at reducing fatty liver, and if enough weight is lost, some studies have even indicated that fibrosis can reverse to some degree. So, the first thing we have to do with these people is encourage therapeutic lifestyle changes as we do, frankly, with everyone.

But it’s also important to recognize that we have not identified most of these people in our practices. So they’re hidden, they’re hidden among our patients. So we need to consider the diagnosis when we see our patients and then we need to look for it. How do we do that? We could do that with an ultrasound, we can do that with a FibroScan, we could do that with an MRI. Liver tests are helpful, but they’re not the be all and end all. There are other biomarkers that are that are maybe coming into practice, but they’re not there yet, things like PRO-C3

But for now, it’s really just thinking about when we see our patients, specifically those patients who have those risks and then aggressively trying to manage those risks. So that’s what we have now, and hopefully next year we’ll have some drugs that have been approved and we’ll have a little better understanding of the relationship between fatty liver and steatohepatitis and cardiovascular disease.

And I wish everyone well, and be healthy, and stay well during COVID, and see you next year.