Jamalinia Mohamad, Zare Fatemeh, Mantovani Alessandro, Targher Giovanni, Lonardo Amedeo
Gastroenterohepatology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
Section of Endocrinology, Diabetes and Metabolism, Department of Medicine, University and Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy.
Diabetes Obes Metab. 2025 Sep;27(9):5171-5181. doi: 10.1111/dom.16568. Epub 2025 Jun 25.
Since sex is a significant modifier of cardiovascular disease (CVD) and metabolic dysfunction-associated steatotic liver disease (MASLD), we performed a meta-analysis to estimate the sex-specific risk of fatal and non-fatal CVD events in adults with MASLD.
We searched four major electronic databases from inception to November 2024 to identify observational cohort studies examining sex-specific associations between MASLD and the risk of fatal and/or non-fatal CVD events. The diagnosis of MASLD and its severity were assessed using serum biomarkers/scores, International Classification of Diseases codes, imaging or histology.
Thirty-six cohort studies with aggregate data on 18.5 million individuals were included (25% with MASLD; 48% women; mean age of 50.2 years). During a median follow-up of 6.9 years (IQR 5.0-12.3), approximately 515 000 fatal and/or non-fatal CVD events occurred (42% in women). MASLD was associated with a higher risk of fatal or non-fatal CVD events in women (pooled hazard ratio [HR] 1.59, 95% confidence interval [CI] 1.44-1.75; I = 96.10%) than in men (pooled HR 1.37, 95% CI 1.27-1.48; I = 96.26%) (p-value for sex difference = 0.018). The severity of MASLD (variably assessed) further increased the magnitude of this risk, especially in women (pooled HR 2.40, 95% CI 1.73-3.32; I = 57.29%). Sensitivity analyses did not modify these findings. The funnel plot and Egger's test showed no significant publication bias.
Women with MASLD are at higher risk of incident fatal and non-fatal CVD events compared with men, especially as the severity of MASLD increases. These findings emphasize the necessity for sex-specific CVD risk assessment and management strategies.
由于性别是心血管疾病（CVD）和代谢功能障碍相关脂肪性肝病（MASLD）的一个重要调节因素，我们进行了一项荟萃分析，以估计患有MASLD的成年人发生致命和非致命CVD事件的性别特异性风险。
我们检索了四个主要电子数据库，从建库至2024年11月，以识别观察性队列研究，这些研究考察了MASLD与致命和/或非致命CVD事件风险之间的性别特异性关联。使用血清生物标志物/评分、国际疾病分类代码、影像学或组织学评估MASLD的诊断及其严重程度。
纳入了36项队列研究，汇总数据涉及约1850万人（约25%患有MASLD；48%为女性；平均年龄50.2岁）。在中位随访6.9年（四分位间距5.0 - 12.3年）期间，发生了约515000例致命和/或非致命CVD事件（42%发生在女性中）。与男性相比，MASLD在女性中与更高的致命或非致命CVD事件风险相关（合并风险比[HR] 1.59，95%置信区间[CI] 1.44 - 1.75；I² = 96.10%），而在男性中合并HR为1.37，95% CI 1.27 - 1.48；I² = 96.26%）（性别差异的p值 = 0.018）。MASLD的严重程度（评估方式各异）进一步增加了这种风险的幅度，尤其是在女性中（合并HR 2.40，95% CI 1.73 - 3.32；I² = 57.29%）。敏感性分析未改变这些结果。漏斗图和Egger检验显示无显著发表偏倚。
与男性相比，患有MASLD的女性发生致命和非致命CVD事件的风险更高，尤其是随着MASLD严重程度的增加。这些发现强调了进行性别特异性CVD风险评估和管理策略的必要性。
