併發心血管疾病的風險與預測

Risk and Prediction of Cardiovascular Disease Complications

心血管疾病（CVD）與代謝相關脂肪肝疾病（MAFLD）之間的關係相當複雜。儘管CVD和MAFLD常有共同的風險因子，但MAFLD患者往往有較高機率會發展CVD，反之亦然。除了生活方式外，胰島素抗性、全身性發炎、氧化壓力、脂肪細胞激素，以及腸道微生物群和基因遺傳，現在也被認為具有一定程度的致病風險。最近由亞太肝臟學會（APASL）、美國心臟學會（AHA）等發布的指引，廣闊地論述了肝臟、心臟和內分泌之間的密切關係。非藥物治療措施包括：飲食控制、生活方式改變、有氧運動和減肥手術等。而關於藥物治療，臨床試驗顯示，第1型類升糖素胜肽受體致效劑（GLP-1 RA）和鈉葡萄糖共同轉運器－2抑制劑（SGLT2i）或可改善肝纖維化。而GLP-1 RA和SGLT2i也可改善心血管風險。其他藥物，包括二甲双胍（metformin），史達汀類（statins）類和維生素E，也被提及可能具有改善CVD和MAFLD之可能性。本文將廣泛地探討有關CVD和MAFLD之間交互作用的可能機轉、臨床醫師如何幫患者做風險評估和管理。

The relationship between cardiovascular diseases (CVDs) and metabolic associated fatty liver disease (MAFLD) is complex. Despite overlapped risk factors for CVDs and MAFLD, patients with MAFLD can develop CVDs and vice versa. Beyond lifestyle, insulin resistance, systemic in􀃀ammation, cytokines, oxidative stress, adipokines, nowadays intestinal microbiota and genetic disorders are also regarded as risk factors. To note, the complex interactions of genetic and environmental risk factors shed light on the disparity in genetic influence on NAFLD and its incident CVD. Recently published guidelines by Asian Pacific Association for the Study of the Liver (APASL), the American Heart Association (AHA), the American Association of Clinical Endocrinology (AACE) and the American Association for the Study of Liver Diseases (AASLD) encompass the fields of liver, heart, and endocrine health. The recommended non-pharmacological interventions include dietary control (Mediterranean diet), lifestyle changes, aerobic exercise, and weight loss surgery, with a suggested weight reduction of 7-10%. Regarding pharmacological interventions, randomized clinical trials and integrated analysis have confirmed that GLP-1 RA can improve liver fibrosis, while the effects of SGLT2 inhibitors on liver fibrosis require further research confirmation. Both GLP-1 RA and SGLT2 inhibitors can improve cardiovascular event risk in patients with type 2 diabetes. Although statins have not shown to improve liver histology, they can reduce the risk of cardiovascular death in MAFLD patients. Other drugs, including metformin and vitamin E, are also mentioned. In this talk, I will briefly introduce the proposed mechanism, risk factors, recommended workflow and management for CVDs and MAFLD.