Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
Department of Internal Medicine, Inje University Ilsan Paik Hospital, Goyang, South Korea.
PLoS One. 2024 Mar 26;19(3):e0301126. doi: 10.1371/journal.pone.0301126. eCollection 2024.
BACKGROUND & AIMS: A new nomenclature, Steatotic Liver Disease (SLD), has been proposed by consensus with sub-classifications and requires evidence-based validation. We assessed whether the presence and severity of SLD, as well as its sub-classifications, are associated with the progression of coronary atherosclerosis.
This longitudinal cohort study included 13,811 adults who participated in repeated regular health screening examinations between January 1, 2004 and December 31, 2021 that included assessments of their coronary artery calcium (CAC) scores. SLD was defined using abdominal ultrasonography and classified as metabolic dysfunction associated steatotic liver disease (MASLD), MASLD with increased alcohol intake (MetALD), and cryptogenic SLD. SLD severity was assessed using fibrosis-4 (FIB-4) scores. The progression of CAC scores was measured using multidetector CT scans.
The average duration of follow-up was 5.8 years. During follow-up, the annual rate of CAC progression in participants with and without SLD was 18% (95% CI 17%-19%) and 14% (95% CI 13%-14%) (p < 0.01), respectively. The multivariable ratios of progression rates when we compared participants with cryptogenic SLD, MASLD, or MetALD with those without SLD were 0.98 (95% CI 0.95-1.01), 1.03 (95% CI 1.03-1.04), and 1.07 (95% CI 1.04-1.09), respectively. The multivariable ratios of progression rates when we compared participants with SLD with FIB-4 score <1.3 and SLD with FIB-4 score ≥1.3 with those without SLD were 1.03 (95% CI 1.02-1.04), and 1.05 (95% CI 1.04-1.06), respectively.
SLD was associated with a higher risk of coronary atherosclerosis, and the risk differed by sub-classifications and severity. These findings suggest that the newly proposed definition has clinical relevance in terms of stratifying cardiovascular disease risk.
通过共识提出了一种新的命名法，即脂肪性肝病（SLD），并对其进行了亚分类，需要进行基于证据的验证。我们评估了 SLD 的存在和严重程度及其亚分类是否与冠状动脉粥样硬化的进展有关。
本纵向队列研究纳入了 13811 名成年人，他们于 2004 年 1 月 1 日至 2021 年 12 月 31 日期间参加了多次定期健康筛查检查，其中包括对其冠状动脉钙（CAC）评分的评估。使用腹部超声检查定义 SLD，并将其分类为代谢功能障碍相关脂肪性肝病（MASLD）、MASLD 伴酒精摄入增加（MetALD）和隐源性 SLD。使用纤维化-4（FIB-4）评分评估 SLD 的严重程度。使用多排 CT 扫描测量 CAC 评分的进展情况。
平均随访时间为 5.8 年。在随访期间，有 SLD 和无 SLD 的参与者 CAC 评分的年进展率分别为 18%（95%CI 17%-19%）和 14%（95%CI 13%-14%）（p<0.01）。与无 SLD 的参与者相比，比较隐源性 SLD、MASLD 或 MetALD 参与者的进展率的多变量比值分别为 0.98（95%CI 0.95-1.01）、1.03（95%CI 1.03-1.04）和 1.07（95%CI 1.04-1.09）。与无 SLD 的参与者相比，比较 SLD 患者 FIB-4 评分<1.3 和 SLD 患者 FIB-4 评分≥1.3 的进展率的多变量比值分别为 1.03（95%CI 1.02-1.04）和 1.05（95%CI 1.04-1.06）。
SLD 与冠状动脉粥样硬化的风险增加相关，其风险因亚分类和严重程度而异。这些发现表明，新提出的定义在分层心血管疾病风险方面具有临床意义。
