Song Jingjing, Liu Yupeng, Liu Ye, Liu Ying, Zhou Qing, Chen Jing, Meng Xiangbin, Wang Wenyao, Tang Yi-Da
Heart Center and Beijing Key Laboratory of Hypertension, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China.
Department of Cardiology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, 510080, China.
Nutr Metab Cardiovasc Dis. 2025 Mar;35(3):103798. doi: 10.1016/j.numecd.2024.103798. Epub 2024 Nov 20.
Patients receiving statin therapy still suffer from adverse cardiovascular events. Metabolic (dysfunction)-associated fatty liver disease (MAFLD) is a newly proposed concept that shares common metabolic risk factors with cardiovascular disease. This study aimed to investigate the association between MAFLD and adverse cardiovascular outcomes in coronary heart disease (CHD) patients with LDL-C<1.8 mmol/L.
CHD patients with LDL-C<1.8 mmol/L were divided into MAFLD and non-MAFLD groups. Propensity score matching (PSM) was used to control for baseline differences between the two groups. The primary endpoint was major adverse cardiac and cerebrovascular events (MACCEs). All MAFLD patients were further stratified into two groups with and without advanced liver fibrosis, according to the Fibrosis-4 (FIB-4) index cutoffs, and the associations between advanced liver fibrosis status and cardiovascular outcomes were analyzed. After PSM, 800 MAFLD and 800 non-MAFLD patients with LDL-C<1.8 mmol/L were analyzed. MAFLD patients exhibited a significantly greater cumulative incidence and risk of MACCEs than non-MAFLD patients (9.6 % versus 6.6 %, p < 0.05; HR 1.48, 95 % CI 1.04-2.1, p < 0.05). Among MAFLD patients with LDL-C<1.8 mmol/L, advanced liver fibrosis staged by the FIB-4 index was associated with an elevated risk for MACCEs (HR 2.91, 95 % CI 1.17-7.19, p < 0.05), all-cause mortality, myocardial infarction (MI) and stent thrombosis.
MAFLD was an independent risk factor for adverse cardiovascular outcomes in CHD patients with LDL-C<1.8 mmol/L. Additionally, advanced liver fibrosis predicts increased risks for adverse cardiovascular events among MAFLD patients. These findings suggest that MAFLD and liver fibrosis screening and management contribute to the residual cardiovascular risk of CHD patients.
接受他汀类药物治疗的患者仍会发生不良心血管事件。代谢（功能障碍）相关脂肪性肝病（MAFLD）是一个新提出的概念，与心血管疾病有共同的代谢危险因素。本研究旨在探讨MAFLD与低密度脂蛋白胆固醇（LDL-C）<1.8 mmol/L的冠心病（CHD）患者不良心血管结局之间的关联。
将LDL-C<1.8 mmol/L的CHD患者分为MAFLD组和非MAFLD组。采用倾向评分匹配（PSM）来控制两组之间的基线差异。主要终点是主要不良心脑血管事件（MACCEs）。根据纤维化-4（FIB-4）指数临界值，将所有MAFLD患者进一步分为有和没有晚期肝纤维化的两组，并分析晚期肝纤维化状态与心血管结局之间的关联。经过PSM后，分析了800例LDL-C<1.8 mmol/L的MAFLD患者和800例非MAFLD患者。MAFLD患者的MACCEs累积发生率和风险显著高于非MAFLD患者（9.6%对6.6%，p<0.05；风险比[HR]1.48，95%置信区间[CI]1.04-2.1，p<0.05）。在LDL-C<1.8 mmol/L的MAFLD患者中，FIB-4指数分期的晚期肝纤维化与MACCEs风险升高（HR 2.91，95%CI 1.17-7.19，p<0.05）、全因死亡率、心肌梗死（MI）和支架血栓形成相关。
MAFLD是LDL-C<1.8 mmol/L的CHD患者不良心血管结局的独立危险因素。此外，晚期肝纤维化预示着MAFLD患者不良心血管事件风险增加。这些发现表明，MAFLD和肝纤维化的筛查与管理有助于降低CHD患者的残余心血管风险。
