Objective We explored clinical implications of the new definition of metabolic dysfunction-associated steatotic liver disease (MASLD) by assessing its prevalence and associated cardiovascular disease (CVD) risk.
Design From nationwide health screening data, we identified 9 775 066 adults aged 20–79 who underwent health examination in 2009. Participants were categorised into four mutually exclusive groups: (1) MASLD; (2) MASLD with increased alcohol intake (MetALD); (3) MASLD with other combined aetiology (the three collectively referred to as MASLD/related steatotic liver disease (SLD)); and (4) no MASLD/related SLD. SLD was determined by fatty liver index ≥30. The primary outcome was CVD event, defined as a composite of myocardial infarction, ischaemic stroke, heart failure or cardiovascular death.
Results The prevalence of MASLD, MetALD and MASLD with other combined aetiology was 27.5%, 4.4% and 1.5%, respectively. A total of 8 808 494 participants without prior CVD were followed up for a median of 12.3 years, during which 272 863 CVD events occurred. The cumulative incidence and multivariable-adjusted risk of CVD were higher in participants with MASLD/related SLD than in those without (HR 1.38 (95% CI 1.37 to 1.39)). Multivariable-adjusted HR (95% CI) of CVD events was 1.39 (1.38 to 1.40) for MASLD, 1.28 (1.26 to 1.30) for MetALD and 1.30 (1.26 to 1.34) for MASLD with other combined aetiology compared to the absence of any of these conditions. CVD risk was also higher in participants with metabolic dysfunction-associated fatty liver disease or non-alcoholic fatty liver disease than in those without the respective condition.
Conclusion Over one-third of Korean adults have MASLD/related SLD and bear a high CVD risk.
- CARDIOVASCULAR DISEASE
- NONALCOHOLIC STEATOHEPATITIS
- FATTY LIVER
- CARDIOVASCULAR COMPLICATIONS
Data availability statement
No data are available.
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H-HL and HAL are joint first authors.
Twitter @HHLee_MD, @hokyoulee
Contributors H-HL, HAL, HL and SUK conceptualised and designed the study. H-HL, HAL, HYK, SHA, HL and SUK performed the literature search. E-JK, HL, H-HL and HAL conducted analysis. All authors contributed to the interpretation of data for the work. HCK, HL and SUK supervised the project. H-HL and HAL drafted the manuscript. HYK, HCK, SHA, HL and SUK critically revised the manuscript for important intellectual content. All authors gave final approval of the version to be submitted. HL and SUK serve as guarantor for the study.
Funding This work was supported by the Basic Science Research Program through the National Research Foundation of Korea funded by the Ministry of Education (grant number 2022R1I1A1A01065244); the Basic Science Research Program through the National Research Foundation of Korea funded by the Ministry of Science and ICT (grant number 2022R1F1A1066181); and the faculty research grant of Yonsei University College of Medicine (grant number 6-2022-0128).
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.
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