Department of Gastroenterology, Beijing Friendship Hospital, Capital Medical University, State Key Laboratory of Digestive Health, National Clinical Research Center for Digestive Diseases, Beijing, China.
Liver Int. 2024 Sep;44(9):2315-2328. doi: 10.1111/liv.15999. Epub 2024 May 31.
To examine the cardiovascular disease (CVD) risks associated with metabolic dysfunction-associated steatotic liver disease (MASLD) and different numbers of cardiometabolic risk factors (CMRFs) in patients with inflammatory bowel disease (IBD) based on a long-term prospective cohort.
Prevalent IBD patients at baseline who were free of CVD, cancer, alcoholic liver disease, cancer and hepatitis B/C virus seropositive were included (N = 4204). MASLD, MASLD subtypes [pure MASLD, MASLD with increased alcohol intake (MetALD)], lean/non-lean MASLD and CMRFs at baseline were defined according to the latest criteria proposed by AASLD and EASL. The primary outcome was incident CVD, including ischaemic heart disease (IHD), heart failure (HF) and stroke. Multivariable Cox proportional hazard models were used to estimate the relationship.
Overall, 1528 (36.4%) were diagnosed with MASLD at baseline. During a median of 13.1-year follow-up, 503 incident CVDs were identified. Compared with IBD-only, IBD-MASLD patients had an increased risk of CVD (HR = 1.77, 95%CI: 1.26-2.49), especially in those with MetALD (HR = 2.34, 1.34-4.11) and lean MASLD (HR = 2.30, 1.13-4.66). As the number of CMRFs increased, the risks of CVD were significantly increased (p <0.001), with a 116% and 92% excess risk in MASLD with 3 CMRFs (HR = 2.16, 1.48-3.15) and ≥4 CMRFs (HR = 1.92, 1.27-2.91). Similar excess risk of incident IHD and HF was observed in IBD-MASLD, either pure MASLD or MetALD, as well as lean/non-lean MASLD.
MASLD is associated with increased CVD risk in IBD patients, with greater risk as number of CMRFs increased and evidently higher risk in MetALD and lean MASLD patients.
本研究基于一项长期前瞻性队列研究，旨在探讨代谢相关脂肪性肝病（MASLD）与炎症性肠病（IBD）患者心血管疾病（CVD）风险的相关性，以及不同数量的心血管代谢危险因素（CMRFs）的相关性。
本研究纳入了基线时无 CVD、癌症、酒精性肝病、HBV/HCV 病毒阳性且无癌症的 IBD 患者（N=4204）。根据 AASLD 和 EASL 最新标准，基线时定义 MASLD、MASLD 亚型[单纯 MASLD、MASLD 合并酒精摄入增加（MetALD）]、瘦型/非瘦型 MASLD 和 CMRFs。主要结局为 CVD 事件，包括缺血性心脏病（IHD）、心力衰竭（HF）和中风。采用多变量 Cox 比例风险模型评估相关性。
总体而言，基线时 1528 例（36.4%）患者诊断为 MASLD。在中位数为 13.1 年的随访期间，共发生 503 例 CVD 事件。与 IBD 患者相比，IBD-MASLD 患者 CVD 风险增加（HR=1.77，95%CI：1.26-2.49），尤其是 MetALD（HR=2.34，1.34-4.11）和瘦型 MASLD（HR=2.30，1.13-4.66）患者。随着 CMRFs 数量的增加，CVD 风险显著增加（p<0.001），在 MASLD 患者中，有 3 个 CMRFs（HR=2.16，1.48-3.15）和≥4 个 CMRFs（HR=1.92，1.27-2.91）时，风险分别增加 116%和 92%。在 IBD-MASLD 患者中，无论单纯 MASLD 还是 MetALD，或瘦型/非瘦型 MASLD，均观察到 IHD 和 HF 事件的发生风险呈类似的增加。
MASLD 与 IBD 患者 CVD 风险增加相关，CMRFs 数量增加与风险增加相关，MetALD 和瘦型 MASLD 患者的风险显著增加。
