Be sure to join here TOMORROW for our FIRST @cardiomet_CE accredited #tweetorial on non-alcoholic fatty #liver disease (#NAFLD) / non-alcoholic steatohepatitis (#NASH) by world-renowned expert Dr Michael Charlton @mcharltonmd at @UChicagoMed !
— cardio-met (@cardiomet_CE) September 27, 2021
1) Welcome to @cardiomet_CE ‘s FIRST EVER #tweetorial on #NAFLD/#NASH–a classic #cardiometabolic diagnosis that shares many features and #riskfactors w/our more usual topics in the cardio-nephro-endo space. Our followers and casual viewers LOVE new education! I am @mcharltonmd. pic.twitter.com/LTfK0CLpG6
— cardio-met (@cardiomet_CE) September 28, 2021
3) Nonalcoholic fatty liver disease (NAFLD) affects ~ 1 in 4 people in North America and Western Europe and > a billion people worldwide. ~ 18% of people with NAFLD have nonalcoholic steatohepatitis (NASH); 3-4% have bridging fibrosis or cirrhosis (Younossi et al Hepatology 2016)
— cardio-met (@cardiomet_CE) September 28, 2021
5) A case highlighting challenges and approach to vexing issues in eval and management of NAFLD: 42y F, BMI 41, Hispanic ethnicity, eval of RUQ “ache” found to have ALT 42, AST 38, PLTs 276, ALB 4.3, ALKP and TBILI nl.
— cardio-met (@cardiomet_CE) September 28, 2021
7) Which of the following should be done next?
— cardio-met (@cardiomet_CE) September 28, 2021
a. Magnetic resonance elastography (MRE)
b. Vibration controlled transient elastography (VCTE)
c. Liver biopsy
d. Stop pravastatin and repeat labs in one month
9) Liver biopsy is not indicated at this point. As CV disease is leading cause of death in NAFLD, pravastatin should not be D/Cd and is very unlikely to be cause of LFT elevations. pic.twitter.com/XntRfryEkR
— cardio-met (@cardiomet_CE) September 28, 2021
11) Liver Bx has obvious limitations and is performed in ~1% of pts w an ICD code for NAFLD or NASH. FIB-4 and NFS have similar performance but can be divergent.
— cardio-met (@cardiomet_CE) September 28, 2021
13) Mark your answer and return tomorrow for the answer and more discussion! You’re on your way to free CE/#CME all about #NAFLD and #NASH–classic #cardiometabolic problems! @SomayaAlbhaisi @theliversurgeon @SanjayaSatapath @HenryEChang @michaelpcurry @Duke_liverdoc @john_ricemd
— cardio-met (@cardiomet_CE) September 28, 2021
15) So, to yesterday’s poll: the answer is YES, until a better predictor of clinical events is available. The presence of F3 or F4 is quite high and would change management. pic.twitter.com/BBAcvcm0B4
— cardio-met (@cardiomet_CE) September 29, 2021
17) The Enhanced Liver Fibrosis (ELF) test, an algorithm incorporating hyaluronate, TIMP-1 & PIIINP levels, was recently approved by FDA for assessing likelihood of progression to cirrhosis & liver-related clinical events in patients w/advanced fibrosis (F3 or F4) due to NASH.
— cardio-met (@cardiomet_CE) September 29, 2021
19) ELF score is primarily an indicator of hepatic fibrosis (https://t.co/Edfh0VA911). pic.twitter.com/zEZjtNZ6FB
— cardio-met (@cardiomet_CE) September 29, 2021
21) Pts w ELF scores <10.5, in addition to lifestyle recommendations, should be reassured that they are unlikely to have advanced disease and they should be retested in 3 years. (https://t.co/2LYXcHUS65)
— cardio-met (@cardiomet_CE) September 29, 2021
23) What treatments should now be considered?
— cardio-met (@cardiomet_CE) September 29, 2021
25) Welcome back! You’re nearing the conclusion (and credit grab) of our first #tweetorial on #NAFLD/#NASH. I’m @mcharltonmd and you have found the only source of accredited, serialized tweetorials in #cardiometabolic medicine! pic.twitter.com/eQW0eukVBy
— cardio-met (@cardiomet_CE) September 30, 2021
27) Phase 2 clinical trials of therapeutic agents for NASH have been disappointing, failing to produce compelling efficacy when compared to placebo. Even the most efficacious agents reported to date fail to improve fibrosis in a substantial majority of treated patients. pic.twitter.com/WDz7PAaCHe
— cardio-met (@cardiomet_CE) September 30, 2021
29) Absent an FDA-approved pharmacotherapy for NASH, a holistic approach to optimizing nutrition and metabolic comorbidities are essential facets of NASH management.
— cardio-met (@cardiomet_CE) September 30, 2021
31) #GLP1RA therapy is FDA approved for T2DM w metformin resistance. Semaglutide is approved for medically complicated obesity.
— cardio-met (@cardiomet_CE) September 30, 2021
33) Many high (class III) BMI pts like to try diet and lifestyle. RCTs have demonstrated a low success rate. We like to give pts who want to try diet and lifestyle alone 3 mos to show success as weight loss trajectory should be apparent by then. pic.twitter.com/z1C6Bl7RJP
— cardio-met (@cardiomet_CE) September 30, 2021
35) #GLP1RAs should be limited to treatment of medically complicated obesity & metformin-resistant #T2D in pts w/NASH. Patients w/NASH meet AHA guidelines for ASA use.
— cardio-met (@cardiomet_CE) September 30, 2021
37) So, 🔑messages for our @cardiomet_CE tweeps: #NASH develops from #NAFLD; 15-25% of the population is thought to have NAFLD, and ~25% of those are likely have NASH.
— cardio-met (@cardiomet_CE) September 30, 2021
39) NASH is the second leading cause for liver transplant in the 🇺🇸, and also carries a risk of developing hepatocellular carcinoma. It’s too bad: patients may have NAFLD for years before progressing to NASH.
— cardio-met (@cardiomet_CE) September 30, 2021
41) . . . and pioglitazone (which ameliorates insulin resistance). Multiple other agents are being studied. For now, early recognition is perhaps the most important thing to ask of our #cardiometabolic care.
— cardio-met (@cardiomet_CE) September 30, 2021
43) For now, your reward: 0.5h CE/#CME for completing a two-minute questionnaire. #physicians #nurses #pharamcists #APPs. Just go to https://t.co/iyrIn63EmY. #FOAMed @MedTweetorials #medtwitter #CardioTwitter @HepCommJournal @TyngYuan @DonaldJensenMD @jfergus75 @NASH_and_coffee pic.twitter.com/MrCXKIe3Re
— cardio-met (@cardiomet_CE) September 30, 2021
TO CLAIM YOUR 0.5h CREDIT: