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Glycemic control target for liver and cardiovascular events risk in metabolic dysfunction-associated steatotic liver

Nobuharu Tamaki1, Shun-Ichi Wakabayashi2, Takefumi Kimura2

  • 1Department of Gastroenterology and Hepatology, Musashino Red Cross Hospital, Tokyo, Japan.

Hepatology Research : the Official Journal of the Japan Society of Hepatology
|February 24, 2024
PubMed

Insights

Optimizing glycemic control in patients with metabolic dysfunction-associated steatotic liver disease (MASLD) is crucial. An HbA1c level of 7% is identified as the optimal threshold to reduce the risk of liver-related events and major adverse cardiovascular events (MACE).

Area of Science:

  • Hepatology
  • Cardiology
  • Endocrinology

Background:

  • Metabolic dysfunction-associated steatotic liver disease (MASLD) is linked to increased risks of liver-related and cardiovascular events.
  • Optimizing glycemic control is a potential strategy to mitigate these risks.
  • The precise hemoglobin A1c (HbA1c) threshold for risk reduction in MASLD patients remains undefined.

Purpose of the Study:

  • To determine the optimal hemoglobin A1c (HbA1c) threshold for minimizing liver-related events and major adverse cardiovascular events (MACE) in patients with MASLD.
  • To investigate the dose-dependent relationship between HbA1c levels and the risk of complications in this population.

Main Methods:

  • A nationwide population-based cohort study included 633,279 patients with MASLD.
  • Annual HbA1c measurements were collected over a mean follow-up of 4.2 years.
  • The primary endpoints were liver-related events and MACE, with statistical analysis to identify the optimal HbA1c threshold.

Main Results:

  • Increased HbA1c levels showed a dose-dependent association with higher risks of both liver-related events and MACE.
  • Specific HbA1c ranges (e.g., ≥9.0%) significantly elevated the risk compared to the reference range (5.0%-5.9%).
  • An HbA1c level of 7% was identified as the optimal threshold, associated with reduced risks (sHR 2.40 for liver events, 1.98 for MACE).

Conclusions:

  • Glycemic control is critical for managing MASLD patients.
  • An HbA1c level of 7% serves as an effective threshold for reducing the risk of liver and cardiovascular complications.
  • Targeting HbA1c below 7% may be a beneficial strategy for patients with MASLD.
Abstract

Keywords:
decompensationhemoglobin A1c (HbA1c)hepatocellular carcinoma (HCC)major adverse cardiovascular event (MACE)metabolic dysfunction‐associated steatotic liver disease (MASLD)

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