Endocrine Abstracts

Background: Metabolic Dysfunction-Associated Steatotic Liver Disease(MASLD) is considered a potential independent risk factor for cardiovascular disease(CVD) as it shares a common risk factor with CVD. We investigated the association with cardiovascular risk according to the metabolic risk factors in patients with MASLD.

Methods: This nationwide study included 1,710,144 individuals aged 40–79 years who underwent health check-ups between 2009 and 2012 in Korea. We excluded previous CVD history, those with viral hepatitis, those who died before follow-up investigation, and missing data. Participants were categorized into no steatotic liver disease(SLD), MASLD, MASLD with increased alcohol intake(MetALD), and alcohol-related liver disease(ALD) and the combination of the presence or absence of risk factor of metabolic syndrome(MetS). Hepatic steatosis was defined as the fatty liver index (FLI) ≥30. MASLD was defined as the presence of at least one of cardiometabolic risk factors: 1) Waist circumference ≥90 cm in men and ≥85 cm in women or body mass index≥23 kg/m²; 2) Blood pressure ≥130/85 mmHg or specific drug treatment; 3) Triglyceride ≥150 mg/dl or specific drug treatment; 4) High-density lipoprotein cholesterol ≤40 mg/dl for men and ≤50 mg/dl for women; 5) Fasting blood glucose levels ≥100 mg/dl or specific drug treatment. The primary outcome was a hospitalization due to CVD and CVD-related mortality. Hospitalization due to CVD was defined as the ICD-10 codes of I21-23, I50, I63. CVD-related mortality was defined as heart disease (I00-99). Cox analyses were used to analyze the association between metabolic dysfunction and MASLD and CVD.

Results: The study population consists of a total of 785.132 participants. There were 370.207 male (47.2%) and 414,529 female (52.8%). During a median 8.6 years of follow up, 46,391 (5.9%) hospitalization, 6,802 (0.9%) CVD-related mortality were detected. When no SLD/risk factor(-) were set as the reference group, in no SLD (FLI <30), the more metabolic risk factors, the higher the adjusted hazard ratio (aHR) in hospitalization and CVD-related mortality. In the FLI ≥30 (SLD), the hospitalization risk and CVD-related mortality was higher than the reference group. Even within the MASLD, the more metabolic risk factors, the higher the aHR, and the highest aHR in the ALD (aHR, 1.86; 95% CI,1.70–2.03) in hospitalization of CVD.

Conclusion: MASLD independently increases CVD-related outcomes, and the importance of MASLD is more emphasized when accompanied by metabolic syndrome. And both MASLD and significant alcohol consumption increased CVD-related outcome.