Metabolic dysfunction associated fatty liver disease identifies subjects with cardiovascular risk better than non‐alcoholic fatty liver disease

• Published in: Liver international Vol. 43; no. 3; pp. 608 - 625
• Main Authors: Chun, Ho Soo, Lee, Minjong, Lee, Jae Seung, Lee, Hye Won, Kim, Beom Kyung, Park, Jun Yong, Kim, Do Young, Ahn, Sang Hoon, Lee, Yong‐Ho, Kim, Ji‐Hye, Kim, Seung Up
• Format: Journal Article
• Language: English
• Published: United States Wiley Subscription Services, Inc 01.03.2023
• Subjects: Arteriosclerosis; Aspartate aminotransferase; Aspartate Aminotransferases; Atherosclerosis; cardiovascular disease; Cardiovascular Diseases; Fatty liver; Fibrosis; Health risks; Heart Disease Risk Factors; Heart diseases; Humans; Liver; Liver Cirrhosis; Liver diseases; liver fibrosis; metabolic dysfunction‐associated fatty liver disease; Metabolism; Non-alcoholic Fatty Liver Disease; Population studies; Risk Factors; Subgroups; Transaminases; cardiovascular disease; liver fibrosis; metabolic dysfunction-associated fatty liver disease; non-alcoholic fatty liver disease
• ISSN: 1478-3223; 1478-3231; 1478-3231
• DOI: 10.1111/liv.15508

Background and Aims Cardiovascular disease (CVD) is the main cause of mortality in subjects with non‐alcoholic fatty liver disease (NAFLD). We investigated the association between CVD risk and metabolic dysfunction‐associated fatty liver disease (MAFLD) or NAFLD and the influence of significant liver fibrosis on the CVD risk. Methods Subjects who underwent a comprehensive medical check‐up were recruited (2014–2019). Significant liver fibrosis was defined using NAFLD fibrosis score, fibrosis‐4 index, aspartate aminotransferase to platelet ratio index, or FibroScan‐aspartate aminotransferase score. High probability of atherosclerotic CVD (ASCVD) was defined as ASCVD risk score > 10%. Results Of the study population (n = 78 762), 27 047 (34.3%) and 24 036 (30.5%) subjects had MAFLD and NAFLD respectively. A total of 1084 (4.0%) or 921 (3.8%) subjects had previous CVD history in MAFLD or NAFLD subgroup respectively. The previous CVD history and high probability of ASCVD were significantly higher in MAFLD or NAFLD subgroup with significant liver fibrosis than in the other groups (all p < .001). In multivariable analysis, MAFLD was independently associated with previous CVD history after adjusting for confounders (adjusted odds ratio [aOR] = 1.10, p = .038), whereas NAFLD was not (all p > .05). MAFLD (aOR = 1.40) or NAFLD (aOR = 1.22) was independently associated with high probability of ASCVD after full adjustment respectively (all p < .001). Significant liver fibrosis was independently associated with previous CVD history and high probability of ASCVD after adjustment in MAFLD or NAFLD subgroup respectively (all p < .05). Conclusion MAFLD might better identify subjects with CVD risk than NAFLD. Fibrosis assessment might be helpful for detailed prognostication in subjects with MAFLD.