Risk of Major Adverse Cardiovascular Outcomes in Families With MASLD: A Population-Based Multigenerational Cohort Study.

IF 6.2 2区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Circulation-Cardiovascular Quality and Outcomes Pub Date : 2024-11-06 DOI:10.1161/CIRCOUTCOMES.124.010912
Fahim Ebrahimi, Ramin Ebrahimi, Hannes Hagström, Johan Sundström, Jiangwei Sun, David Bergman, Anders Forss, Jonas F Ludvigsson
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Abstract

Background: Metabolic dysfunction-associated steatotic liver disease (MASLD) is a risk factor for cardiovascular disease. However, whether family members of individuals with MASLD also share an increased cardiovascular risk is unknown.

Methods: We created a nationwide multigenerational cohort study identifying all family members of Swedish adults diagnosed with biopsy-proven MASLD (1969-2017) and of matched general population comparators (by age, sex, calendar year, and county of residence). We calculated incidence rates and used Cox models to calculate adjusted hazard ratios (aHRs) and 95% CIs for incident major adverse cardiovascular events (MACE), including acute myocardial infarction, stroke, hospitalization for heart failure, or cardiovascular death. Cox models were adjusted for education, country of birth, diabetes, hypertension, obesity, dyslipidemia, chronic kidney disease, chronic obstructive pulmonary disease, and the Charlson comorbidity index.

Results: We identified 22 267 MASLD first-degree relatives (FDRs; parents, siblings, and offspring) and 5687 MASLD spouses, as well as 118 056 comparator FDRs and 29 389 comparator spouses without earlier cardiovascular disease. Overall, the mean age was 41.8 years (SD, 18.0), and 51.5% were females. Over a median of 24.6 years, the incidence rate for MACE was higher in MASLD FDRs than in comparator FDRs (65.0 versus 62.5/10 000 person-years; aHR, 1.06 [95% CI, 1.01-1.11]). MASLD FDRs had higher rates of acute myocardial infarction (23.0 versus 20.9/10 000 person-years; aHR, 1.09 [95% CI, 1.01-1.18]) and cardiovascular death (aHR, 1.09 [95% CI, 1.01-1.18]). Across generations of FDRs, the risk of MACE was uniformly increased with no differences by relationship (ie, parents, siblings, and offspring; Pinteraction>0.05). MASLD spouses were also at an increased risk of MACE (117.6 versus 103.5/10 000 person-years; aHR, 1.09 [95% CI, 1.01-1.18]).

Conclusions: First-degree relatives of individuals with biopsy-proven MASLD are at slightly higher risk of incident MACE, but absolute risks do not support early screening for cardiovascular disease. Shared lifestyle factors may be the main contributors, as spouses of MASLD patients also had higher risks of MACE.

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MASLD家族主要不良心血管后果的风险:一项基于人群的多代队列研究。
背景:代谢功能障碍相关性脂肪性肝病(MASLD)是心血管疾病的一个危险因素。然而,代谢功能障碍相关性脂肪性肝病患者的家庭成员是否也会增加心血管风险尚不清楚:我们在全国范围内开展了一项多代队列研究,确定了经活检证实患有 MASLD 的瑞典成年人的所有家庭成员(1969-2017 年),以及与之相匹配的普通人群比较对象(按年龄、性别、日历年和居住地所在县划分)。我们计算了发病率,并使用 Cox 模型计算了主要不良心血管事件(包括急性心肌梗死、中风、心力衰竭住院或心血管死亡)的调整危险比 (aHR) 和 95% CI。Cox模型对教育程度、出生国家、糖尿病、高血压、肥胖、血脂异常、慢性肾病、慢性阻塞性肺病和Charlson合并症指数进行了调整:我们确定了 22 267 位 MASLD 一级亲属(FDRs;父母、兄弟姐妹和后代)和 5 687 位 MASLD 配偶,以及 118 056 位无早期心血管疾病的参照 FDRs 和 29 389 位参照配偶。总体而言,平均年龄为 41.8 岁(标度为 18.0),51.5% 为女性。在中位 24.6 年的时间里,MASLD FDR 的 MACE 发生率高于参照 FDR(65.0 对 62.5/10,000人年;aHR,1.06 [95% CI,1.01-1.11])。MASLD FDRs 的急性心肌梗死率(23.0 对 20.9/10,000人-年;aHR,1.09 [95% CI,1.01-1.18])和心血管死亡率(aHR,1.09 [95% CI,1.01-1.18])较高。在各代 FDRs 中,MACE 风险均呈上升趋势,且无关系差异(即父母、兄弟姐妹和后代;Pinteraction>0.05)。MASLD配偶的MACE风险也增加了(117.6对103.5/10 000人年;aHR,1.09 [95% CI,1.01-1.18]):结论:经活检证实的MASLD患者的一级亲属发生MACE的风险略高,但绝对风险并不支持对心血管疾病进行早期筛查。共同的生活方式可能是主要原因,因为MASLD患者的配偶发生MACE的风险也较高。
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来源期刊
Circulation-Cardiovascular Quality and Outcomes
Circulation-Cardiovascular Quality and Outcomes CARDIAC & CARDIOVASCULAR SYSTEMS-
CiteScore
8.50
自引率
2.90%
发文量
357
审稿时长
4-8 weeks
期刊介绍: Circulation: Cardiovascular Quality and Outcomes, an American Heart Association journal, publishes articles related to improving cardiovascular health and health care. Content includes original research, reviews, and case studies relevant to clinical decision-making and healthcare policy. The online-only journal is dedicated to furthering the mission of promoting safe, effective, efficient, equitable, timely, and patient-centered care. Through its articles and contributions, the journal equips you with the knowledge you need to improve clinical care and population health, and allows you to engage in scholarly activities of consequence to the health of the public. Circulation: Cardiovascular Quality and Outcomes considers the following types of articles: Original Research Articles, Data Reports, Methods Papers, Cardiovascular Perspectives, Care Innovations, Novel Statistical Methods, Policy Briefs, Data Visualizations, and Caregiver or Patient Viewpoints.
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