Emerging Liver–Heart Link in Type 1 Diabetes: New Review Calls for Broader Cardiometabolic Assessment
April 30, 2025
A newly published review from UPMC Children’s Hospital of Pittsburgh highlights the growing recognition of the link between liver health and cardiovascular risk in individuals with type 1 diabetes (T1D). The article, titled "Relationship between Liver and Cardiometabolic Health in Type 1 Diabetes," was published in Frontiers in Endocrinology and co-authored by Emir Tas, MD; Katherine Vu-Boast, MD; Ingrid Libman, MD, PhD; and Radhika Muzumdar, MD, chief of the Division of Pediatric Endocrinology — all from the Division of Pediatric Endocrinology — along with Brenda Mendizabal, MD, Director of Pediatric Preventive Cardiology from the Heart Institute at UPMC Children’s.
MASLD: A Missed Risk Factor in T1D?
Although metabolic dysfunction-associated steatotic liver disease (MASLD) has traditionally been linked to obesity and type 2 diabetes, its relevance in type 1 diabetes (T1D) is increasingly recognized. Emerging evidence suggests that excessive liver fat accumulation may independently elevate cardiovascular disease (CVD) risk in T1D, especially among patients with coexisting features such as obesity, insulin resistance, and dyslipidemia.
Proposed mechanisms include hepatic insulin resistance, chronic systemic inflammation, and pro-atherogenic lipid markers, which may collectively contribute to elevated cardiometabolic risk—beyond what is captured by traditional markers like hypertension, dyslipidemia, and glycemic control.
The review also underscores gaps in current screening practices and emphasizes the need to incorporate liver health into a more comprehensive approach to cardiometabolic risk assessment in T1D.
Clinical Takeaways
The authors suggest that screening for MASLD in at-risk individuals with T1D — particularly those with obesity or suboptimal glycemic control — may be warranted. While there are currently no approved pharmacologic treatments for MASLD, early recognition could help guide lifestyle interventions and inform cardiovascular risk stratification, potentially offering long-term benefits for this vulnerable population.
Reference
Tas E, Vu-Boast K, Mendizabal B, Libman I, Muzumdar R. Relationship between liver and cardiometabolic health in type 1 diabetes. Front Endocrinol (Lausanne). 2024; 15:1505430. (Note: Review is open access.)
