Trejo Mario Jesus, Floyd James S, Massera Daniele, Daviglus Martha, Garcia-Bedoya Olga, Cai Jianwen, Talavera Gregory A, Tamayo-Murillo Dorathy E, Labovitz Daniel, Kaplan Robert
Public Health Sciences Division, Fred Hutchinson Cancer Center, Seattle, WA, USA.
Cardiovascular Health Research Unit, Department of Medicine, University of Washington, Seattle, WA, USA.
BMC Gastroenterol. 2025 Jul 30;25(1):543. doi: 10.1186/s12876-025-04133-1.
BACKGROUND: Metabolic dysfunction-associated steatotic liver disease (MASLD) increases risk of cardiovascular disease (CVD). Despite the high prevalence of MASLD among Hispanic populations, there is a scarcity of research on the associations between non-invasive markers of liver disease and incident CVD and all-cause mortality. In this study we investigated the association of liver related biomarkers with CVD events and all-cause mortality in a population based Hispanic/Latino cohort. METHODS: We included 15,216 participants from the Hispanic Community Health Study/Study of Latinos (HCHS/SOL) aged 18-74 years with no pre-existing CVD. The composite outcome combined incident CVD and all-cause mortality. Having "elevated ALT/AST" was defined as ALT > 40 IU/mL or AST > 37 IU/mL for males, and ALT or AST > 31 IU/mL for females. We estimated adjusted hazard ratios (HR) and 95% confidence intervals (CI) relating our composite outcome to elevated ALT/AST, FIB-4 and MASLD. Using interaction terms, we assessed whether the relationship between elevated ALT/AST and the composite outcome differed by MASLD status. RESULTS: The study population was 40 years old on average, 52.7% female and had 740 CVD or all-cause mortality events. Elevated FIB-4 had the strongest association with incident CVD or all-cause mortality (comparing FIB-4 > 2.67 versus ≤ 2.67, HR:3.47; CI:2.34-5.14). Elevated AST was found to be associated with incident CVD or all-cause mortality (HR:1.53; CI:1.14-2.05). MASLD was not associated with incident CVD or all-cause mortality (HR:1.14; CI: 0.94-1.40), but it was associated with incident CVD alone (HR:1.69; CI:1.19-2.39). The relationship between elevated ALT/AST and incident or all-cause mortality was modified by MASLD, such that the strongest association between elevated ALT/AST and incident CVD or all-cause mortality was in the absence of MASLD (HR:1.95; CI:1.20-3.18). CONCLUSIONS: Among Hispanic adults FIB-4 was strongly associated with CVD or all-cause mortality and among persons without MASLD, elevated ALT/AST were associated with CVD or all-cause mortality.
背景：代谢功能障碍相关脂肪性肝病（MASLD）会增加心血管疾病（CVD）的风险。尽管MASLD在西班牙裔人群中患病率很高，但关于肝病非侵入性标志物与CVD事件及全因死亡率之间关联的研究却很匮乏。在本研究中，我们调查了基于人群的西班牙裔/拉丁裔队列中肝脏相关生物标志物与CVD事件及全因死亡率之间的关联。 方法：我们纳入了来自西班牙裔社区健康研究/拉丁裔研究（HCHS/SOL）的15216名年龄在18 - 74岁且无既往CVD的参与者。复合结局包括新发CVD和全因死亡率。男性“ALT/AST升高”定义为ALT＞40 IU/mL或AST＞37 IU/mL，女性为ALT或AST＞31 IU/mL。我们估计了将复合结局与ALT/AST升高、FIB - 4和MASLD相关联的校正风险比（HR）和95%置信区间（CI）。使用交互项，我们评估了ALT/AST升高与复合结局之间的关系是否因MASLD状态而异。 结果：研究人群平均年龄为40岁，女性占52.7%，发生了740例CVD或全因死亡事件。FIB - 4升高与新发CVD或全因死亡率的关联最强（比较FIB - 4＞2.67与≤2.67，HR：3.47；CI：2.34 - 5.14）。发现AST升高与新发CVD或全因死亡率相关（HR：1.53；CI：1.14 - 2.05）。MASLD与新发CVD或全因死亡率无关（HR：1.14；CI：0.94 - 1.40），但仅与新发CVD相关（HR：1.69；CI：1.19 - 2.39）。ALT/AST升高与新发或全因死亡率之间的关系因MASLD而改变，因此ALT/AST升高与新发CVD或全因死亡率之间的最强关联出现在无MASLD的情况下（HR：1.95；CI：1.20 - 3.18）。 结论：在西班牙裔成年人中，FIB - 4与CVD或全因死亡率密切相关，在无MASLD的人群中，ALT/AST升高与CVD或全因死亡率相关。
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