Long-term cardiovascular outcomes differ across metabolic dysfunction-associated fatty liver disease subtypes among middle-aged population

• DOI: 10.1007/s12072-022-10407-7
• Publication Date: 2022-09-07T10:06:09Z
• Authors: Hokyou Lee; Tae Seop Lim; Seung Up Kim; Hyeon Chang Kim
• Keywords: Male; Liver Cirrhosis; 0301 basic medicine; Metabolic dysfunction-associated fatty liver disease; Myocardial Infarction; Subtype; 610; 03 medical and health sciences; Risk Factors; Non-alcoholic Fatty Liver Disease; Fatty liver; Humans; Obesity; Non-alcoholic Fatty Liver Disease* / epidemiology; Obesity / epidemiology; Liver Diseases; Middle Aged; Cardiovascular disease; 16. Peace & justice; Myocardial Infarction* / epidemiology; Obesity / complications; 3. Good health; Liver Diseases*; Liver Cirrhosis / epidemiology; Female; Non-alcoholic fatty liver disease

The new metabolic dysfunction-associated fatty liver disease (MAFLD) criteria include the following three distinct subtypes: MAFLD with diabetes mellitus (DM), overweight/obese (OW), or lean/normal weight with metabolic dysfunction. We investigated whether long-term cardiovascular disease outcomes differ across the MAFLD subtypes.From a nationwide health screening database, we included 8,412,730 participants (48.6% males) aged 40-64 years, free of cardiovascular disease history, between 2009 and 2010. Participants were categorized into non-MAFLD, OW-MAFLD, lean-MAFLD, and DM-MAFLD. The primary outcome was a composite cardiovascular disease event, including myocardial infarction, ischemic stroke, heart failure, or cardiovascular disease-related death. The presence of advanced liver fibrosis was estimated using a BARD score ≥ 2.Among the study participants, 3,087,640 (36.7%) had MAFLD, among which 2,424,086 (78.5%), 170,761 (5.5%), and 492,793 (16.0%) had OW-MAFLD, lean-MAFLD, and DM-MAFLD, respectively. Over a median follow-up period of 10.0 years, 169,433 new cardiovascular disease events occurred. With the non-MAFLD group as reference, multivariable-adjusted hazard ratios (95% confidence intervals) for cardiovascular disease events were 1.16 (1.15-1.18), 1.23 (1.20-1.27), and 1.82 (1.80-1.85) in the OW-MAFLD, lean-MAFLD, and DM-MAFLD groups, respectively. Participants with lean-MAFLD or DM-MAFLD had a higher cardiovascular disease risk than those with OW-MAFLD, irrespective of metabolic abnormalities or comorbidities. The presence of advanced liver fibrosis was significantly associated with a higher cardiovascular disease risk in each MAFLD subtype.Long-term cardiovascular disease outcomes differed across the MAFLD subtypes. Further studies are required to investigate whether preventive or therapeutic interventions should be optimized according to the MAFLD subtypes.