Abstract
BACKGROUND & AIMS: Patients with metabolic dysfunction-associated steatotic liver disease (MASLD) and high cardiovascular risk often have advanced liver fibrosis, but data on associations and outcomes are limited. The aim of this study was to evaluate the relationships between cardiovascular risk categories and liver fibrosis severity, liver fibrosis progression, and liver-related events (LREs) in MASLD.
METHODS: Patients with MASLD from the VCTE-Prognosis cohort were stratified into low, intermediate, and high cardiovascular risk categories using the Framingham Risk Score (FRS), Primary Care Equivalents (PCE), or Predicting Risk of Cardiovascular Disease EVENTs (PREVENT) scores. Outcomes included the prevalence of advanced fibrosis (liver stiffness ≥10 kPa), liver stiffness progression (≥20% increase and Baveno category upshift), and LRE (hepatocellular carcinoma, hepatic decompensation, liver transplantation, or liver-related mortality). Associations were assessed using multivariable logistic regression and Fine-Gray competing-risks models.
RESULTS: Among 9312 patients with MASLD (mean age, 54.4 ± 11.0 years; 56.8% male; 87.4% Asian), advanced fibrosis prevalence increased with cardiovascular risk: adjusted odds ratios (ORs) were 2.72 (95% confidence interval [CI], 2.25-3.28; P < .001) for FRS, 1.83 (95% CI, 1.46-2.29; P < .001) for PCE, and 2.93 (95% CI, 2.33-3.69; P < .001) for PREVENT. Over a median follow-up of 4.5 years, liver stiffness progression occurred in 5.0% of patients, more frequently in high-risk groups (adjusted subdistribution hazard ratio [SHR], 1.56; 95% CI, 1.14-2.15; P = .006 for PCE and adjusted SHR, 1.85; 95% CI, 1.33-2.56; P < .001 for PREVENT). LREs occurred in 1.4% of patients, with higher incidence in high-risk groups (adjusted SHR, 2.12; 95% CI, 1.19-3.77; P = .010 for FRS; adjusted SHR, 2.01; 95% CI, 1.08-3.74; P = .027 for PCE; and adjusted SHR, 2.80; 95% CI, 1.40-5.61; P = .004 for PREVENT).
CONCLUSIONS: Higher cardiovascular risk is associated with greater prevalence of advanced liver fibrosis, liver stiffness progression, and LRE incidence in MASLD.