Association of Life's Essential 8 with Hepatic Fibrosis, MASLD, and MetALD in the Framingham Heart Study

Background: Metabolic dysfunction-associated steatotic liver disease (MASLD), metabolic dysfunction and alcohol-associated liver disease (MetALD), and related fibrosis are increasingly prevalent conditions. The relation of the American Heart Association's (AHA) cardiovascular health (CVH) metric Life's Essential 8 (LE8) with MASLD, MetALD, and hepatic fibrosis remains unclear. We aimed to investigate the associations of CVH with MASLD, MetALD, and hepatic fibrosis. Methods: We defined significant hepatic fibrosis as a liver stiffness ≥8.2 kPa measured by vibration-controlled transient elastography. MASLD was defined as steatosis (controlled attenuation parameter of ≥274 dB/m) with ≥1 cardiometabolic risk factor and mild alcohol intake (≤140 g/week [women]; ≤210 g/week [men]). MetALD was defined as steatosis with ≥1 cardiometabolic risk factor and moderate alcohol intake (141-350 g/week [women]; 211-420 g/week [men]). Data from 2962 participants in the Framingham Heart Study (mean age 59 years, 57% women) were used in multivariable-adjusted logistic regression models, accounting for demographic and clinical covariates to relate CVH and liver outcomes. Results: Our study included 2704 participants with mild and 258 with moderate alcohol use. MASLD and MetALD prevalence was 34% and 40%, respectively, and 9% had significant hepatic fibrosis. Each 10-point increase in LE4 score (composite of diet, sleep health, physical activity, and smoking) was associated with 16% lower odds of MASLD (Odds Ratio [OR] 0.84; 95% CI: 0.80-0.90; p < 0.001) but not MetALD. Each 10-point increase in LE8 score was associated with 17% lower odds of hepatic fibrosis (OR 0.83; 95% CI: 0.78-0.89; p < 0.001). Conclusions: Better CVH is related to lower odds of MASLD and significant hepatic fibrosis.