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Updated: Jul 2, 2025

Optimized Analysis of In Vivo and In Vitro Hepatic Steatosis
Published on: March 11, 2017
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.
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.
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