Вплив ліраглутиду та дапагліфлозину на серцево-судинний ризик у пацієнтів зі стеатотичною хворобою печінки, асоційованою з метаболічною дисфункцією

Objective: to assess and compare lipid profiles in patients with metabolic dysfunction-associated steatotic liver disease (MASLD) before and after treatment with liraglutide or dapagliflozin, as well as to evaluate cardiovascular risk using five stratified scales and analyze intergroup differences. Materials and methods. This prospective, randomized, parallel-group study included 115 patients of both sexes, aged 26–67 years, with MASLD. Participants were divided into three groups: a control group (CG) (36 patients), Group IA (41 patients), and Group IB (38 patients). The CG was advised to follow the Mediterranean diet and engage in moderate-intensity physical activity for 150 minutes per week. Group IA followed the same non-pharmacological recommendations, with the addition of dapagliflozin 10 mg once daily. Group IB also adhered to the same non-pharmacological regimen, along with liraglutide, starting at a dose of 0.6 mg once daily, gradually increasing to 1.8 mg weekly. All groups followed the assigned recommendations for three months. At the baseline visit, lipid profile indicators, blood pressure, and cardiovascular risk was assessed using five stratified risk scales: the Globorisk tool, Framingham Risk Score (10-year cardiovascular diseases (CVD) risk estimation), American College of Cardiology (ACC) / American Heart Association (AHA) ASCVD Risk Calculator (10-year risk of heart disease or stroke; algorithm published in 2013), Prospective Cardiovascular Münster (PROCAM) Score, and the World Health Organization (WHO) CVD risk chart. After three months, these indicators were reassessed, and cardiovascular risk was recalculated. Results. Significant improvements in lipid profile indicators were observed in all groups after treatment. Total cholesterol, low-density lipoprotein (LDL), and triglycerides decreased significantly, while high-density lipoprotein (HDL) levels increased (p < 0.001 for all). HDL levels showed a more pronounced increase in Group IB compared to the CG (p = 0.02). Cardiovascular risk decreased significantly in all groups (p < 0.05), with consistent reductions observed across all five scales. No statistically significant intergroup differences in cardiovascular risk reduction were found (p > 0.05). Conclusions. Both liraglutide and dapagliflozin significantly improved lipid profiles and reduced cardiovascular risk in patients with MASLD. Total cholesterol, LDL, and triglycerides decreased significantly in all groups, while HDL levels increased, with a more pronounced effect in the liraglutide group. No significant intergroup differences were observed in total cholesterol, LDL, triglycerides, or cardiovascular risk reductions, suggesting similar efficacy of both treatments in these aspects. However, the greater increase in HDL levels in the liraglutide group highlights its potential advantage in modifying lipid metabolism.