Background and Aims:Metabolic dysfunction-associated steatohepatitis (MASH) affects approximately 5% of adults globally and, without effective treatment, may progress to end-stage liver disease (ESLD), including compensated cirrhosis, decompensated cirrhosis (DC), hepatocellular carcinoma, and liver transplantation. Using real-world data, this study characterized the natural history and health-care impact of MASH among US adults. Methods:A retrospective cohort study was conducted using Optum's deidentified Market Clarity Data (January 2021-March 2024). Noninvasive test (NIT) use at diagnosis (days 0-30) and during follow-up was described. Predictors of progression were estimated with modified Poisson regression, time to first ESLD was assessed with Cox models, and health-care resource utilization (HCRU) and costs with multivariable regression. Results:Among 49,983 patients with MASH, 16,359 (32.7%) had ESLD at baseline (compensated cirrhosis 3965; DC 11,406; hepatocellular carcinoma 514; liver transplantation 474). Of the 33,624 without baseline ESLD, 15.9% progressed; median time to first ESLD event was 10.6 months (interquartile range: 3.8-19.7), with DC the most frequent first event. Around diagnosis, 3771 patients (7.5%) underwent ≥1 NIT or imaging test, slightly higher with baseline ESLD than without (8.1% vs 7.3%); NIT/imaging use increased during follow-up. Older age, hypertension, type 2 diabetes, cardiovascular disease, sleep apnea, smoking, and thyroid disease were associated with higher progression risk. Patients who progressed had higher HCRU and costs than those who did not progress. Conclusion:In this large US cohort, progression from MASH to ESLD was associated with high HCRU and costs, particularly among patients with ESLD or subsequent progression. These findings highlight the need for earlier risk stratification and targeted care to mitigate burden.

Metabolic dysfunction-associated steatotic liver disease (MASLD) is now recognized as a multisystem disease closely linked to cardiovascular disease, which is the leading cause of death in this population. MASLD and cardiovascular disease share overlapping pathophysiological mechanisms including insulin resistance, chronic inflammation, oxidative stress, and endothelial dysfunction that not only drive the progression of each disease but may also potentiate one another. Recent initiatives, such as the cardiovascular-kidney-metabolic health framework and the cardiovascular-renal-hepatic-metabolic model, underscore the importance of integrated, multidisciplinary care for managing multisystemic conditions like MASLD. In this context, cardiologists who frequently encounter MASLD-related comorbidities such as diabetes and obesity are well positioned to lead efforts in early detection, risk stratification, and management. This review offers cardiologists a comprehensive overview of MASLD, including the epidemiology, diagnostic approaches, and therapeutic options of MASLD while highlighting cardiologists' pivotal role in its multidisciplinary management.