Department of Gastroenterology and Hepatology, Musashino Red Cross Hospital, Tokyo, Japan.
Division of Gastroenterology, Department of Medicine, Shinshu University School of Medicine, Nagano, Japan.
Aliment Pharmacol Ther. 2024 Oct;60(8):1033-1041. doi: 10.1111/apt.18205. Epub 2024 Aug 8.
The diagnosis of metabolic dysfunction-associated steatotic liver disease (MASLD) requires at least one of five cardiometabolic criteria. It is unclear whether these criteria can be used as predictors and treatment targets for complications including liver-related events and major adverse cardiovascular events (MACE).
To investigate the relationship between cardiometabolic criteria and complications.
We conducted a nationwide, population-based study of 979,352 patients with MASLD. We investigated relationships between a number of criteria at baseline and liver-related events or MACE risks. In a separate longitudinal analysis, we included patients with five criteria at baseline and investigated the relationship between improving the criteria and the incidence of complications after 1 year.
The cumulative incidence of MACE, but not liver-related events, increased with increasing baseline cardiometabolic criteria. In the longitudinal study, multivariable analysis using patients with five criteria (no improvement) as the reference, adjusted hazard ratios (95% confidence interval) of MACE in patients with 4, 3, 2, and 0-1 criteria (1 to 4-5 criteria improvement) were 0.55 (0.52-0.58, p < 0.001), 0.20 (0.17-0.22, p < 0.001), 0.13 (0.11-0.16, p < 0.001), and 0.06 (0.02-0.3, p < 0.001), respectively. The risk of MACE decreased as the cardiometabolic criteria improved. There was no significant association between improvement of the criteria and liver-related events.
Cardiometabolic criteria can be used as predictors and treatment targets for cardiovascular event risk in MASLD. Developing predictors and therapeutic targets for liver-related events is a future challenge.
代谢功能障碍相关脂肪性肝病 (MASLD) 的诊断需要至少符合五个心血管代谢标准中的一个。这些标准是否可以作为包括肝相关事件和主要不良心血管事件 (MACE) 在内的并发症的预测指标和治疗靶点尚不清楚。
探讨心血管代谢标准与并发症之间的关系。
我们进行了一项针对 979352 例 MASLD 患者的全国性、基于人群的研究。我们调查了基线时的多项标准与肝相关事件或 MACE 风险之间的关系。在一项单独的纵向分析中，我们纳入了基线时符合五项标准的患者，并研究了改善标准与 1 年后并发症发生率之间的关系。
MACE 的累积发生率增加，但肝相关事件无此变化，且随基线心血管代谢标准的增加而增加。在纵向研究中，使用基线时符合五项标准（无改善）的患者作为参考，多变量分析调整后的 MACE 风险比（95%置信区间）为符合四项、三项、两项和零至一项标准（一至四项标准改善）的患者分别为 0.55（0.52-0.58，p<0.001）、0.20（0.17-0.22，p<0.001）、0.13（0.11-0.16，p<0.001）和 0.06（0.02-0.3，p<0.001）。心血管代谢标准的改善降低了 MACE 的风险。标准改善与肝相关事件之间无显著关联。
心血管代谢标准可作为 MASLD 心血管事件风险的预测指标和治疗靶点。开发肝相关事件的预测指标和治疗靶点是未来的挑战。
