Cardiovascular Risk Assessment Tools are Insufficient for Patients With Metabolic Dysfunction-Associated Steatotic...

Area of Science:

• Cardiology
• Hepatology
• Public Health

Background:

• Cardiovascular (CV) event risk is typically estimated using Framingham Risk Score (FRS), Pooled Cohort Equation (PCE), and AHA PREVENT equation.
• The accuracy of these established risk assessment tools in patients with Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD) remains uncertain.

Purpose of the Study:

• To evaluate the predictive accuracy of FRS, PCE, and PREVENT for 5-10 year CV events in a real-world MASLD cohort.
• To assess the calibration and discrimination of these risk prediction models in the MASLD population.

Main Methods:

• Analysis of US adults (≥30 years) with MASLD from the TARGET-NASH study.
• Estimation of CV risk using original and recalibrated FRS and PCE, and original PREVENT equation.
• Assessment of model discrimination (C-statistic) and calibration (Hosmer-Lemeshow test).

Main Results:

• The Framingham Risk Score (FRS) showed weak predictive ability (C-statistic 0.58).
• The AHA PREVENT model also demonstrated limited discrimination (C-statistic 0.60).
• Both FRS and PCE exhibited significant calibration issues, overestimating risk in high-risk groups and underestimating in low-risk groups.

Conclusions:

• Standard cardiovascular risk prediction tools are inadequate for patients with MASLD.
• There is a critical need for improved risk assessment strategies to address the high mortality from CV events in MASLD patients.