Aim:
This study assessed and compared changes in lipid profile and cardiovascular risk in patients with metabolic dysfunction-associated steatotic liver disease after six months of liraglutide or dapagliflozin treatment. We also evaluated changes in N-terminal pro-B-type natriuretic peptide levels.

Material and methods:
This prospective, randomized, parallel-group study included 115 adult patients with metabolic dysfunction-associated steatotic liver disease. Participants were randomized into three groups: control (n = 36, lifestyle intervention only), dapagliflozin (n = 41, 10 milligrams daily), or liraglutide (n = 38, titrated to 1.8 milligrams daily). All patients adhered to a Mediterranean diet and moderate physical activity. Lipid profile and N-terminal pro-B-type natriuretic peptide levels were measured at baseline and six months. Cardiovascular risk was assessed using five validated scales: Globorisk, Framingham Risk Score, American College of Cardiology/American Heart Association atherosclerotic cardiovascular disease Risk Calculator, Prospective Cardiovascular Münster Score, and World Health Organization cardiovascular risk charts.

Results:
All groups showed significant within-group improvements in total cholesterol, low-density lipoprotein cholesterol, triglycerides, and high-density lipoprotein cholesterol (p < 0.001), with liraglutide showing greater lipid improvements intergroup (p < 0.05). Cardiovascular risk scores decreased significantly in all groups, with no differences between them. N-terminal pro-B-type natriuretic peptide levels increased significantly in the control and liraglutide groups, but remained unchanged in the dapagliflozin group.

Conclusions:
Liraglutide and dapagliflozin are effective in improving lipid profile and reducing cardiovascular risk. Liraglutide showed superior efficacy in lipid improvement. Changes in N-terminal pro-B-type natriuretic peptide require further investigation.