Higher Life’s Essential 8 Score for Cardiovascular Health Linked to Reduced MASLD Risk

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New research is providing clinicians with an overview of the association between cardiovascular health and the risk of developing metabolic dysfunctional-associated steatotic liver disease (MASLD).¹

Leveraging National Health and Nutrition Examination Survey (NHANES) 2017-March 2020 data and using the American Heart Association (AHA)’s Life’s Essential 8 (LE8) score as a benchmark of cardiovascular health, investigators determined individuals with “moderate” or “high” scores faced a reduced risk of MASLD relative to those with a “low” LE8 score.¹

MASLD, formerly known as nonalcoholic fatty liver disease (NAFLD), is estimated to affect more than 30% of the global population. Dyslipidemia, obesity, insulin resistance, and type 2 diabetes are known risk factors for developing MASLD.^2,3

“Given substantial evidence indicating that MASLD shares many risk factors with cardiovascular disease and is closely related to cardiovascular disease, LE8 may serve as a promising tool for assessing MASLD risk,” Jin-Yan Zhang, of the department of gastroenterology and hepatology at The First Affiliated Hospital of Xiamen University in China, and colleagues wrote.¹ “However, there is currently limited research investigating the relationship between cardiovascular health and MASLD.”

To address this gap in knowledge, investigators examined NHANES data for adults ≥ 20 years of age and applied the LE8 score to assess cardiovascular health. The score comprises 4 health behaviors, including diet; physical activity; nicotine exposure; and sleep, as well as 4 health factors, including BMI; blood pressure; blood glucose; and non-high-density lipoprotein (non-HDL) cholesterol. Health behavior scores were derived from questionnaire responses, while health factors were derived from physical examination measurements and laboratory analyses of blood samples.¹

Overall cardiovascular health scores were calculated by averaging the scores of the 8 metrics, with higher scores on a 0-100 scale indicating better health. In accordance with AHA guidelines, overall cardiovascular health, healthy behaviors, and health factors were classified into 3 categories: low (0–49 points); moderate (50–79 points); and high (80–100 points).¹

Investigators identified hepatic steatosis using a median CAP of ≥ 285 dB/m. MASLD was defined as the presence of hepatic steatosis; at least 1 of 5 cardiometabolic risk factors; and the absence of excessive alcohol consumption, defined as ≥ 2 drinks for women and ≥ 3 drinks for men.¹

In total, the study included 5680 participants with a weighted mean age of 48.03 years who were predominantly female (50.8%). Among the cohort, the weighted mean LE8 score was 68.25 (Standard error [SE], 0.44).¹

Among the 36.83% of participants diagnosed with MASLD, investigators observed lower LE8 scores than those without MASLD. Additionally, they called attention to a significantly reduced MASLD prevalence in the high cardiovascular health group (12.0%; 95% CI, 10.1–14.2%) than in the moderate (40.8%; 95% CI, 39.3–42.4%) and low (62.0%; 95% CI, 58.4–65.5%) cardiovascular health groups.¹

In a fully adjusted logistic regression model, participants with moderate cardiovascular health (odds ratio [OR], 0.50; 95% CI, 0.37–0.69) and high cardiovascular health (OR, 0.21; 95% CI, 0.13–0.34) had a reduced risk of MASLD when compared with those with low cardiovascular health (P <.001 for trend). Investigators pointed out the OR for MASLD was 0.68 (95% CI, 0.61–0.77) for each 10-point increase in LE8 score.¹

Further analysis revealed a non-linear dose-response relationship between LE8 score and health factors score with MASLD, while a linear relationship was found between health behaviors score and MASLD. Additional subgroup and sensitivity analyses showed a consistent negative correlation between LE8 score and MASLD.¹

“These findings highlight the importance of maintaining optimal cardiovascular health as a potential preventive measure against MASLD,” investigators concluded.¹ “Future research should focus on exploring the causal relationship between cardiovascular health and MASLD, as well as elucidating the underlying mechanisms.”

References

1. ^{Huang LZ, Ni ZB, Huang WF, et al. Association between cardiovascular health and metabolic dysfunction-associated steatotic liver disease: a nationwide cross-sectional study. J Health Popul Nutr. https://doi.org/10.1186/s41043-025-00745-1}
2. ^{American Association for the Study of Liver Diseases. New MASLD Nomenclature. Accessed January 20, 2025. https://www.aasld.org/new-masld-nomenclature}
3. ^{Cleveland Clinic. Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD). November 3, 2024. Accessed January 20, 2025. https://my.clevelandclinic.org/health/diseases/22437-non-alcoholic-fatty-liver-disease}