Yin Szu-Ching, Chen Yi-Ting, Chang Wei-Ting, Chen Tzu-I, Yang Tsai-Hsuan, Liu Xia-Rong, Huang Chia-Wei, Chen Yu-Wei, Lee Mei-Hsuan
Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
Division of Cardiology, Department of Internal Medicine, Chi Mei Medical Center, Tainan, Taiwan.
JHEP Rep. 2025 Jun 6;7(9):101479. doi: 10.1016/j.jhepr.2025.101479. eCollection 2025 Sep.
BACKGROUND & AIMS: The associations between metabolic dysfunction-associated steatotic liver disease (MASLD) and specific cardiovascular events, as well as their attributable burdens, remain inconsistent and underexplored within a single population. This large-scale prospective cohort evaluated the associations between MASLD and various cardiovascular outcomes. Two additional steatotic liver disease (SLD) subtypes - MASLD with increased alcohol consumption (MetALD) and alcohol-related liver disease (ALD) - were also evaluated.
We included 303,589 adults aged ≥30 years from Taiwan who underwent health examinations between 1997 and 2013. MASLD was defined by ultrasound-detected steatosis, limited alcohol intake, and ≥1 cardiometabolic risk factor. MetALD and ALD were defined based on alcohol intake thresholds and cardiometabolic profiles. Participants were followed until 2020, with outcomes and mortality ascertained via linkage to national registries. Cox proportional hazards models were used to estimate adjusted relative risks (RRs), and population attributable fractions (PAFs) were calculated.
Of the total population, 91,877 (30.3%) had MASLD, 7,490 (2.5%) had MetALD, 5,576 (1.8%) had ALD, and 198,646 (65.4%) did not have SLD. Over a median follow-up of 10.4 years, 162,959 cardiovascular events occurred. The adjusted RR of any cardiovascular diseases was 1.29 (95% CI 1.38-1.31) for MASLD, 1.38 (95% CI 1.34-1.42) for MetALD, and 1.48 (95% CI 1.43-1.53) for ALD. Among all SLD subtypes, MASLD showed the highest RR for myocardial infarction (RR 1.46, 95% CI 1.36-1.56). Findings remained consistent after accounting for liver-related deaths. The PAF for MASLD was 8.07% (95% CI 7.81-8.58). Despite higher risks, MetALD and ALD had lower PAFs due to lower prevalence.
All major SLD subtypes - MASLD, MetALD, and ALD - were associated with increased long-term cardiovascular risk, underscoring the need for early detection and cardiometabolic risk management across the SLD spectrum.
This large-scale study of 303,589 individuals demonstrates that metabolic dysfunction-associated steatotic liver disease (MASLD) increases the risk of cardiovascular diseases by at least 29%. Cardiovascular risk further escalates across SLD subtypes with higher levels of alcohol consumption. Notably, MASLD was associated with the highest risk of myocardial infarction among all SLD subtypes. By quantifying population burden, we found that 8.07% of cardiovascular events may be preventable through effective MASLD prevention strategies, highlighting the critical role of cardiometabolic risk management. These findings emphasize the need to integrate MASLD identification and prevention into broader cardiometabolic care and public health frameworks.
not applicable.
在单一人群中，代谢功能障碍相关脂肪性肝病（MASLD）与特定心血管事件之间的关联及其可归因负担仍不一致且未得到充分研究。这项大规模前瞻性队列研究评估了MASLD与各种心血管结局之间的关联。另外两种脂肪性肝病（SLD）亚型——饮酒量增加的MASLD（MetALD）和酒精性肝病（ALD）——也进行了评估。
我们纳入了1997年至2013年间在台湾接受健康检查的303589名年龄≥30岁的成年人。MASLD的定义为超声检测到的脂肪变性、有限的酒精摄入量以及≥1种心血管代谢危险因素。MetALD和ALD根据酒精摄入量阈值和心血管代谢特征进行定义。对参与者进行随访直至2020年，通过与国家登记处的链接确定结局和死亡率。使用Cox比例风险模型估计调整后的相对风险（RRs），并计算人群归因分数（PAFs）。
在总人群中，91877人（30.3%）患有MASLD，7490人（2.5%）患有MetALD，5576人（1.8%）患有ALD，198646人（65.4%）没有SLD。在中位随访10.4年期间，发生了162959例心血管事件。MASLD发生任何心血管疾病的调整后RR为1.29（95%CI 1.38 - 1.31），MetALD为1.38（95%CI 1.34 - 1.42），ALD为1.48（95%CI 1.43 - 1.53）。在所有SLD亚型中，MASLD发生心肌梗死的RR最高（RR 1.46，95%CI 1.36 - 1.56）。在考虑与肝脏相关死亡后，结果仍然一致。MASLD的PAF为8.07%（95%CI 7.81 - 8.58）。尽管风险较高，但由于患病率较低，MetALD和ALD的PAF较低。
所有主要的SLD亚型——MASLD、MetALD和ALD——都与长期心血管风险增加有关，强调了在整个SLD范围内进行早期检测和心血管代谢风险管理的必要性。
这项对303589人的大规模研究表明，代谢功能障碍相关脂肪性肝病（MASLD）使心血管疾病风险增加至少29%。随着酒精摄入量增加，SLD亚型的心血管风险进一步升高。值得注意的是，在所有SLD亚型中，MASLD发生心肌梗死的风险最高。通过量化人群负担，我们发现8.07%的心血管事件可通过有效的MASLD预防策略预防，突出了心血管代谢风险管理的关键作用。这些发现强调了将MASLD的识别和预防纳入更广泛的心血管代谢护理和公共卫生框架的必要性。
不适用。
