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

Background and aims

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).

Methods and results

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.

Conclusions

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.