Research Elucidates MASLD Association With Cardiovascular Disease

Min Kyu Kang, MD, MS

Credit: ResearchGate

Metabolic dysfunction-associated steatotic liver disease (MASLD) predicted a higher risk of atherosclerotic cardiovascular disease (ASCVD) more effectively than metabolic dysfunction-associated fatty liver disease (MAFLD) in a recent preprint paper.¹

“Due to the recent change in the nomenclature, the relationship between MASLD and the risk of CVD remains uncertain. Given the high predictive value of MAFLD for predicting the risk of CVD, it is important to elucidate the association between MASLD and CVD risk and compare it to that of MAFLD,” lead investigator Min Kyu Kang, MD, MS, assistant professor, Yeungnam University, and colleagues wrote.¹

Kang and colleagues included patients who simultaneously underwent ultrasonography to diagnose hepatic steatosis and cardiac computed tomography to detect coronary artery calcification (CAC). They stratified patients according to presence and severity of CAC and into groups by evidence of MASLD (reference), MASLD-only, MAFLD-only, and overlapping groups.

The investigators found that of all included participants, 28.2% (n = 1060/2773) had CAC and 18.5% (n = 196) had severe CAC. Prevalence of MASLD was 32.6%, prevalence of MAFLD was 45.2%, and there was an overlap of 30.7%. Both MASLD (adjusted odd ratios [aOR], 1.21 [95% CI, 1.02–1.44]; P = .033) and MAFLD (aOR, 1.20 [95% CI, 1.01–1.42]; P = .034) were associated with CAC in an ASCVD risk score-adjusted model. Only MASLD (aOR, 1.38 [95% CI, 1.01–1.89]; P = .041) was associated with severe CAC. Compared to the reference group, overlapping MASLD and MAFLD was associated with CAC (aOR, 1.22 [95% CI, 1.01–1.47]; P = .038) whereas the MASLD and MAFLD subgroups alone in comparison to reference were not significantly associated with CAC (P >.05).¹

“In conclusion, beyond being associated with the presence of CAC, independent of traditional risk factors, MASLD was more effective than MAFLD in identifying severe CAC. Moreover, compared with the definition of MAFLD, the new MASLD nomenclature might not show any gap in the prediction of CVD risk using the CAC score. Therefore, the assessment and stratification of CAC may be useful in predicting a high risk of CVD events in patients with MASLD,” Kang and colleagues concluded.¹

Kang and colleagues noted that their study had several limitations, including its cross-sectional retrospective nature, its population of voluntary visitors to the health center able to afford the full tests, and its restricted origin in South Korea. They noted that further research, including longitudinal studies, should be conducted to assess the validity of the proposed associations.

Other recent research into MASLD found that liver complications related to the disease (LC-MASLD) have increased globally between 1990–2021, especially in economically disadvantaged countries. An analysis of the Global Burden of Diseases Study 2021 found that LC-MASLD rose annually by 0.73% in incidence and prevalence, 0.19% in mortality and 0.16% in DALYs between 1990 and 2021. Specifically, the global age-standardized incidence rate (ASIR) of LC-MASLD increased from 475.5 (95% UI [432.6–518.2]) to 593.3 per 100 000 (95% UI [542.7–643.7]), with an EAPC of 0.73 (95% CI [0.69–0.77]). AS prevalence rate similarly rose from 12 085.1 (95% UI [11 058.4–13 184.3]) to 15 018.1 per 100 000 (95% UI [13 756.5–16 147.6]), with an EAPC of 0.73 (95% CI [0.67–0.79]).²

“Advocating for orchestrated international collaboration in MASLD prevention and management, particularly in low-income countries, is imperative. Urgent action is also necessary to formulate comprehensive strategies at both national and global levels to confront the challenge of MASLD,” lead investigator Fang Lu, China-Australia Joint Research Center for Infectious Diseases, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi, People's Republic of China, and colleagues wrote.²

REFERENCES

1. Kang MK, Song J, Loomba R, et al. Comparative associations of MASLD and MAFLD with the presence and severity of coronary artery calcification. Preprint. Res Sq. 2024;rs.3.rs-3979461. Published 2024 Mar 5. doi:10.21203/rs.3.rs-3979461/v1

2. Lu F, Liu J, She B, Yang H, Ji F, Zhang L. Global Trends and Inequalities of Liver Complications Related to Metabolic Dysfunction-Associated Steatotic Liver Disease: An Analysis From 1990 to 2021. Liver Int. Published online October 14, 2024. Doi: 10.1111/liv.16120