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Original research
Metabolic dysfunction-associated steatotic liver disease and risk of cardiovascular disease
  1. Hyeok-Hee Lee1,2,
  2. Han Ah Lee3,
  3. Eun-Jin Kim1,2,
  4. Hwi Young Kim3,
  5. Hyeon Chang Kim1,2,
  6. Sang Hoon Ahn4,5,
  7. Hokyou Lee1,2,
  8. Seung Up Kim4,5
  1. 1Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, South Korea
  2. 2Institute for Innovation in Digital Healthcare, Yonsei University, Seoul, South Korea
  3. 3Department of Internal Medicine, Ewha Womans University College of Medicine, Seoul, South Korea
  4. 4Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea
  5. 5Yonsei Liver Center, Severance Hospital, Seoul, South Korea
  1. Correspondence to Prof. Hokyou Lee, Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, South Korea; hokyou.lee{at}yuhs.ac; Prof. Seung Up Kim, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea; ksukorea{at}yuhs.ac

Abstract

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
  • LIVER
  • CARDIOVASCULAR COMPLICATIONS

Data availability statement

No data are available.

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Footnotes

  • 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.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.