Outcome-Specific Cardiovascular and Hypertensive Risk Profiles in Metabolic Dysfunction-Associated Steatotic Liver...

Area of Science:

• Cardiology
• Hepatology
• Metabolic Diseases

Background:

• Metabolic dysfunction-associated steatotic liver disease (MASLD) affects 25% of adults globally and is a known cardiovascular risk factor.
• The differential impact of MASLD on various cardiometabolic outcomes, such as cardiovascular disease (CVD) and hypertension (HTN), remains incompletely understood.

Purpose of the Study:

• To investigate the outcome-specific associations between MASLD and incident CVD and HTN in a large Asian cohort.
• To determine if MASLD uniformly elevates risk across different cardiometabolic outcomes or if associations vary by outcome type.

Main Methods:

• Analysis of 24,384 adults from a Japanese health-screening program (2007-2022) with a median follow-up of 5.2 years.
• MASLD diagnosis based on ultrasonography-confirmed hepatic steatosis and metabolic dysfunction.
• Application of time-dependent Cox regression, multistate modeling, and Fine-Gray competing risk analysis to assess associations with major adverse cardiovascular events and new-onset arterial HTN.

Main Results:

• MASLD prevalence was 23.8%, significantly increasing CVD risk (aHR: 1.83; 95% CI: 1.63-2.07) with a dose-dependent effect.
• MASLD was not significantly associated with incident HTN (aHR: 1.02; 95% CI: 0.95-1.09).
• Competing risk analysis and multistate models confirmed MASLD preferentially progresses to CVD rather than HTN, accounting for 17.0% of all CVD events.

Conclusions:

• MASLD substantially elevates cardiovascular risk but has a minimal association with hypertension.
• Findings challenge the assumption of uniform cardiometabolic risk in MASLD.
• Emphasizes the need for outcome-specific risk stratification and targeted CVD prevention strategies for patients with MASLD.