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CHAIN Cohort: Prospective Multicenter Study of MASLD With Serial Liver Stiffness Assessments in Cardiovascular Care

Xiao-Dong Zhou1, Ren Cheng-Han Fan2, Jian-Dong Chen3

  • 1MAFLD Research Center, Department of Hepatology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.

Liver International : Official Journal of the International Association for the Study of the Liver
|July 16, 2026
PubMed

Insights

Metabolic dysfunction-associated steatotic liver disease (MASLD) is common in cardiovascular patients but often missed. The CHAIN cohort study will track liver and heart health to improve integrated care and risk assessment.

Area of Science:

  • Cardiology
  • Hepatology
  • Epidemiology

Background:

  • Metabolic dysfunction-associated steatotic liver disease (MASLD) is highly prevalent in patients with cardiovascular disease (CVD).
  • MASLD is underrecognized in routine cardiology practice, highlighting a gap in integrated care.
  • Limited prospective data exist on MASLD progression and its clinical impact in CVD populations.

Purpose of the Study:

  • To establish the CHAIN cohort, a prospective study to investigate the progression and clinical impact of MASLD in patients undergoing coronary evaluation.
  • To provide longitudinal evidence for improved risk stratification and integrated heart-liver management in cardiovascular care.

Main Methods:

  • Prospective, multicenter study enrolling ~15,000 adults undergoing coronary evaluation in China.
  • Baseline assessment includes cardiometabolic profiling and vibration-controlled transient elastography for liver fibrosis and steatosis.
  • Long-term follow-up with repeated liver assessments (every 6-12 months) and monitoring of primary (liver/cardiovascular events) and secondary outcomes.

Main Results:

  • Data collection and analysis are ongoing.
  • The study aims to elucidate the associations between longitudinal changes in liver fibrosis/steatosis and cardiometabolic risk factors/clinical outcomes.

Conclusions:

  • The CHAIN cohort will provide crucial longitudinal evidence on the interplay between MASLD and cardiovascular disease.
  • Findings are expected to support enhanced risk stratification and integrated heart-liver management strategies.
  • This research addresses a critical need for better recognition and management of MASLD in cardiology settings.

Keywords:
cardiometabolic diseasecardiovascular riskliver fibrosismetabolic dysfunction‐associated steatotic liver diseasevibration‐controlled transient elastography

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