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Metabolic dysfunction associated fatty liver disease identifies subjects with cardiovascular risk better than
Ho Soo Chun1,2,3, Minjong Lee1,2, Jae Seung Lee3,4
1Department of Internal Medicine, Ewha Womans University Medical Center, Seoul, South Korea.
Insights
Metabolic dysfunction-associated fatty liver disease (MAFLD) is more strongly linked to cardiovascular disease (CVD) risk than non-alcoholic fatty liver disease (NAFLD). Significant liver fibrosis in MAFLD patients further increases CVD risk, aiding prognostication.
Area of Science:
- Hepatology
- Cardiology
- Metabolic Diseases
Background:
- Cardiovascular disease (CVD) is a leading cause of mortality in patients with non-alcoholic fatty liver disease (NAFLD).
- Emerging evidence suggests metabolic dysfunction-associated fatty liver disease (MAFLD) may have a distinct association with CVD risk compared to NAFLD.
- The impact of liver fibrosis on CVD risk in these conditions requires further investigation.
Purpose of the Study:
- To compare the association between CVD risk and MAFLD versus NAFLD.
- To evaluate the influence of significant liver fibrosis on CVD risk in patients with MAFLD and NAFLD.
- To determine if MAFLD is a better indicator of CVD risk than NAFLD.
Main Methods:
- A cohort of 78,762 subjects undergoing medical check-ups (2014-2019) was analyzed.
- Significant liver fibrosis was assessed using validated scoring systems (NAFLD fibrosis score, FIB-4, APRI) and FibroScan-AST.
- High atherosclerotic CVD (ASCVD) risk was defined as an ASCVD risk score >10%.
Main Results:
- MAFLD was diagnosed in 34.3% and NAFLD in 30.5% of subjects.
- MAFLD was independently associated with a history of CVD (aOR=1.10, p=0.038), while NAFLD was not.
- Both MAFLD (aOR=1.40) and NAFLD (aOR=1.22) were independently associated with a high ASCVD risk.
- Significant liver fibrosis was associated with increased CVD history and high ASCVD risk in both MAFLD and NAFLD groups (all p<0.05).
Conclusions:
- MAFLD may be a more effective marker for identifying individuals at risk of CVD compared to NAFLD.
- Assessing liver fibrosis in MAFLD patients can provide valuable prognostic information regarding cardiovascular risk.
Background And Aims:
Cardiovascular disease (CVD) is the main cause of mortality in subjects with non-alcoholic fatty liver disease (NAFLD). We investigated the association between CVD risk and metabolic dysfunction-associated fatty liver disease (MAFLD) or NAFLD and the influence of significant liver fibrosis on the CVD risk.
Methods:
Subjects who underwent a comprehensive medical check-up were recruited (2014-2019). Significant liver fibrosis was defined using NAFLD fibrosis score, fibrosis-4 index, aspartate aminotransferase to platelet ratio index, or FibroScan-aspartate aminotransferase score. High probability of atherosclerotic CVD (ASCVD) was defined as ASCVD risk score > 10%.
Results:
Of the study population (n = 78 762), 27 047 (34.3%) and 24 036 (30.5%) subjects had MAFLD and NAFLD respectively. A total of 1084 (4.0%) or 921 (3.8%) subjects had previous CVD history in MAFLD or NAFLD subgroup respectively. The previous CVD history and high probability of ASCVD were significantly higher in MAFLD or NAFLD subgroup with significant liver fibrosis than in the other groups (all p < .001). In multivariable analysis, MAFLD was independently associated with previous CVD history after adjusting for confounders (adjusted odds ratio [aOR] = 1.10, p = .038), whereas NAFLD was not (all p > .05). MAFLD (aOR = 1.40) or NAFLD (aOR = 1.22) was independently associated with high probability of ASCVD after full adjustment respectively (all p < .001). Significant liver fibrosis was independently associated with previous CVD history and high probability of ASCVD after adjustment in MAFLD or NAFLD subgroup respectively (all p < .05).
Conclusion:
MAFLD might better identify subjects with CVD risk than NAFLD. Fibrosis assessment might be helpful for detailed prognostication in subjects with MAFLD.
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