Department of Preventive Medicine, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea.
Department of Internal Medicine, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea.
Hepatol Int. 2022 Dec;16(6):1308-1317. doi: 10.1007/s12072-022-10407-7. Epub 2022 Sep 7.
The new metabolic dysfunction-associated fatty liver disease (MAFLD) criteria include the following three distinct subtypes: MAFLD with diabetes mellitus (DM), overweight/obese (OW), or lean/normal weight with metabolic dysfunction. We investigated whether long-term cardiovascular disease outcomes differ across the MAFLD subtypes.
From a nationwide health screening database, we included 8,412,730 participants (48.6% males) aged 40-64 years, free of cardiovascular disease history, between 2009 and 2010. Participants were categorized into non-MAFLD, OW-MAFLD, lean-MAFLD, and DM-MAFLD. The primary outcome was a composite cardiovascular disease event, including myocardial infarction, ischemic stroke, heart failure, or cardiovascular disease-related death. The presence of advanced liver fibrosis was estimated using a BARD score ≥ 2.
Among the study participants, 3,087,640 (36.7%) had MAFLD, among which 2,424,086 (78.5%), 170,761 (5.5%), and 492,793 (16.0%) had OW-MAFLD, lean-MAFLD, and DM-MAFLD, respectively. Over a median follow-up period of 10.0 years, 169,433 new cardiovascular disease events occurred. With the non-MAFLD group as reference, multivariable-adjusted hazard ratios (95% confidence intervals) for cardiovascular disease events were 1.16 (1.15-1.18), 1.23 (1.20-1.27), and 1.82 (1.80-1.85) in the OW-MAFLD, lean-MAFLD, and DM-MAFLD groups, respectively. Participants with lean-MAFLD or DM-MAFLD had a higher cardiovascular disease risk than those with OW-MAFLD, irrespective of metabolic abnormalities or comorbidities. The presence of advanced liver fibrosis was significantly associated with a higher cardiovascular disease risk in each MAFLD subtype.
Long-term cardiovascular disease outcomes differed across the MAFLD subtypes. Further studies are required to investigate whether preventive or therapeutic interventions should be optimized according to the MAFLD subtypes.
新的代谢相关脂肪性肝病（MAFLD）标准包括以下三种不同的亚型：伴有糖尿病（DM）的 MAFLD、超重/肥胖（OW）或代谢功能障碍的消瘦/正常体重的 MAFLD。我们研究了 MAFLD 各亚型的长期心血管疾病结局是否存在差异。
我们从全国性健康筛查数据库中纳入了 8412730 名（48.6%为男性）年龄在 40-64 岁、无心血管疾病史的参与者，这些参与者于 2009 年至 2010 年间入组。参与者被分为非 MAFLD、OW-MAFLD、消瘦-MAFLD 和 DM-MAFLD。使用 BARD 评分≥2 来估计是否存在晚期肝纤维化。
在研究参与者中，3087640 名（36.7%）患有 MAFLD，其中 2424086 名（78.5%）、170761 名（5.5%）和 492793 名（16.0%）患有 OW-MAFLD、消瘦-MAFLD 和 DM-MAFLD。在中位随访 10.0 年期间，有 169433 例新发心血管疾病事件。与非 MAFLD 组相比，多变量校正后的心血管疾病事件风险比（95%置信区间）分别为 1.16（1.15-1.18）、1.23（1.20-1.27）和 1.82（1.80-1.85），OW-MAFLD、消瘦-MAFLD 和 DM-MAFLD 组分别如此。消瘦-MAFLD 或 DM-MAFLD 组的心血管疾病风险高于 OW-MAFLD 组，无论是否存在代谢异常或合并症。晚期肝纤维化的存在与每种 MAFLD 亚型的心血管疾病风险升高显著相关。
MAFLD 各亚型的长期心血管疾病结局存在差异。需要进一步研究以确定是否应根据 MAFLD 亚型优化预防或治疗干预措施。
