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Metabolic dysfunction-associated steatotic liver disease and risk of heart failure: a nationwide cohort study

Chan Kyeol Kim1, Sangyong Jo2, Kyupin Ha1

  • 1Dong-A University College of Medicine, Busan, Korea (the Republic of).

Heart (British Cardiac Society)
|December 16, 2025
PubMed
Abstract

Insights

Metabolic dysfunction-associated steatotic liver disease (MASLD) independently increases heart failure risk. Managing MASLD and cardiometabolic risk factors is crucial for preventing heart failure.

Area of Science:

  • Cardiology
  • Hepatology
  • Metabolic Diseases

Background:

  • Metabolic dysfunction-associated steatotic liver disease (MASLD) shares pathways with heart failure.
  • Previous research on MASLD and heart failure risk is limited by small sample sizes and broad risk factor groupings.

Purpose of the Study:

  • To determine the independent association between MASLD and heart failure incidence.
  • To evaluate the combined impact of specific cardiometabolic risk factors (CMRFs) on heart failure risk in the context of MASLD.

Main Methods:

  • Analysis of 218,605 Korean adults from 2009-2010 screening cohort.
  • MASLD defined by Fatty Liver Index ≥30 with at least one CMRF; exclusion of other liver diseases, alcohol abuse, cancer, cirrhosis.
  • Incident heart failure identified until 2019; multivariable Cox proportional hazards models used for adjusted hazard ratios (HRs).

Main Results:

  • 32% of participants had MASLD, exhibiting less favorable cardiometabolic profiles.
  • During ~9.6 years follow-up, 16,340 heart failure cases occurred.
  • MASLD was linked to a 2.62-fold higher heart failure risk (aHR 2.62); risk increased with more CMRFs (aHR per CMRF 1.24).

Conclusions:

  • MASLD is an independent predictor of incident heart failure, beyond traditional CMRFs.
  • MASLD should be considered in heart failure risk stratification strategies.
  • Early identification and management of MASLD may help mitigate heart failure risk.
Keywords:
Heart failure

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