Metabolic dysfunction-associated steatotic liver disease, liver fibrosis and risk of cardiovascular disease: A prospective cohort study

• Published in: Nutrition, metabolism, and cardiovascular diseases metabolism, and cardiovascular diseases, 2024-12, Vol.34 (12), p.2623-2629
• Main Authors: Baek, Ji Woo, Yang, Yeun Soo, Jung, Keum Ji, Kimm, Heejin, Kim, So Young, Lee, Sunmi, Jee, Sun Ha
• Format: Article
• Language: English
• Subjects: Advanced fibrosis; Cardiovascular diseases; Metabolic dysfunction-associated steatotic liver disease; Prospective cohort
• ISSN: 0939-4753; 1590-3729; 1590-3729
• DOI: 10.1016/j.numecd.2024.09.001

In patients with NAFLD, liver fibrosis increases liver-related complications, but there is controversy about the increase in CVD. Based on a prospective cohort study, this study investigated the risk of cardiovascular disease due to liver fibrosis in patients with metabolic dysfunction-associated steatotic liver disease (MASLD). This study analyzed KCPS-II prospective cohort that tracked 104,399 people who participated in health check-ups at 18 institutions nationwide from 2004 to 2013. If the fatty liver index was 30 or higher, it was defined as SLD, and participants were classified into No-SLD, MASLD, MetALD, ALD, and Cryptogenic SLD. Liver fibrosis was defined by the FIB-4 index, and the occurrence of cardiovascular disease according to SLD classification was analyzed using Cox proportional model regression analysis. Out study included a total of 6,942 participants (6.6%) had MASLD, 6,694 (6.4%) had MetALD, 4,751 (4.6%) had ALD, and 382 (0.3%) had Cryptogenic SLD. For the cases of FIB-4 index ≥1.3, the multivariable-adjusted HR (95% CI) of cardiovascular disease was 2.27 (1.87-2–76) in MASLD, 1.67 (1.30–2.10) in MetALD, and 2.56 (1.99–3.30) in ALD, but it was 0.78 (0.19–3.10) in Cryptogenic_SLD, which was not significant. The risk of cardiovascular disease according to the fibrosis stage classified by BARD also presented similar results. This prospective cohort study of Korean patients with newly defined MASLD, MetALD, and ALD with FIB-4 ≥ 1.3 at high risk of developing cardiovascular disease. •Using the new definition of SLD subgroups, the aim was to assess the prognosis of each group by analyzing the association between FIB-4 and CVD.•Non-invasive approaches to patients with SLD may help identify the risk group for advanced fibrosis.•In the KCPS-II prospective cohort, MASLD, MetALD, and ALD patients have a high risk of CVD when FIB-4 ≥ 1.30.•This is the first study to report the association between newly defined MASLD and the risk of CVD by FIB-4.