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Metabolic dysfunction-associated steatotic liver disease and incident coronary events with revascularization: A nationwide cohort study

2026-04-01T00:00:00Z

Title: Metabolic dysfunction-associated steatotic liver disease and incident coronary events with revascularization: A nationwide cohort study Authors: Kim, Minhong; Lee, Hyun-Ah; Kim, Joungyoun; Kang, Hee-Taik Abstract: Background and aims: Metabolic dysfunction-associated steatotic liver disease (MASLD), a new diagnostic category replacing non-alcoholic fatty liver disease (NAFLD), is strongly linked to cardiovascular diseases. Most previous studies defined cardiovascular outcomes broadly and relied only on diagnostic codes, limiting clinical specificity. We aimed to investigate whether MASLD, defined using the fatty liver index (FLI), is associated with an increased risk of acute coronary syndrome (ACS) and myocardial infarction (MI) with revascularization in the Korean general population. Methods: We analyzed 211,881 adults from the Korean NHIS-HEALS cohort who underwent health screening in 2009-2010. MASLD was defined using the fatty liver index (FLI >= 30) in combination with at least one metabolic risk factor, while excluding heavy alcohol intake and viral hepatitis. The primary outcomes were ACS and MI with revascularization, identified using both diagnostic and procedure codes. Cox proportional hazards models were applied, adjusting for cardiovascular, lifestyle, and socioeconomic factors. Results: Individuals with MASLD had a higher cumulative incidence of ACS and MI compared with non-MASLD. Compared to those without MASLD, fully adjusted HRs (95% CIs) for ACS with revascularization were 1.34 (1.16-1.55) and 1.35 (1.08-1.68) in men with intermediate-risk and high-risk MASLD, and 1.44 (1.16-1.79) and 1.16 (0.76-1.77) in women. A comparable association was found for MI with revascularization. Conclusions: MASLD was significantly associated with an increased risk of ACS and MI with revascularization. These findings support MASLD as an early marker and potential preventive target for atherosclerotic cardiovascular disease.

Combined Impact of Triglyceride-Glucose Index and Alanine Aminotransferase on Steatotic Liver Disease and Subtypes

2026-03-01T00:00:00Z

Title: Combined Impact of Triglyceride-Glucose Index and Alanine Aminotransferase on Steatotic Liver Disease and Subtypes Authors: Kwon, Yu-Jin; Kim, Minhong; Heo, Seok-Jae; Lee, Ji-Won Abstract: Background and Aim: The triglyceride-glucose (TyG) index and alanine aminotransferase (ALT) are emerging biomarkers linked to metabolic disturbances and liver health. Nonetheless, the combined impact of these markers on predicting new-onset steatotic liver disease (SLD) and its metabolic and alcohol-associated subtypes remains unclear. This study aimed to investigate the association of TyG and ALT, individually and combined, in incident SLD in the Korean Genome and Epidemiology Study (KoGES) and UK Biobank cohorts. Methods: This study utilized data from two large population-based cohorts: KoGES (adults aged 40-69 years from South Korea [2001-2002]) and UK Biobank (participants aged 37-73 years from the United Kingdom [2006-2010]). Participants without baseline SLD were classified into four groups based on TyG index and ALT levels, and the incidence of SLD was compared among these groups to assess risk. Results: Elevated baseline TyG index and ALT levels were significantly associated with a higher risk of new-onset SLD and its subtypes in both cohorts. The highest HRs and ORs were observed in individuals with both markers elevated (2.39 in KoGES; 3.89 in UK Biobank). Survival analyses confirmed significantly lower survival probabilities in high-risk groups (p < 0.001). Predictive accuracy was highest with the combined TyG index + ALT model, outperforming either marker alone (p < 0.001). Conclusions: Elevated combined baseline TyG index and ALT levels were significantly associated with increased risk of SLD and its subtypes. Combined use of these markers may be valuable for early identification and risk stratification of individuals at risk for SLD.

Response to the Letter to the Editor concerning "Associations of Individual Beverage Types and Substitution with Dementia Risk

2026-03-01T00:00:00Z

Title: Response to the Letter to the Editor concerning "Associations of Individual Beverage Types and Substitution with Dementia Risk Authors: Kim, Jung-Hwan; Heo, Seok-Jae; Kwon, Yu-Jin; Lee, Ji-Won

Dynamic Smoking Patterns and Risk of Parkinson Disease and All-Cause Mortality

2026-03-01T00:00:00Z

Title: Dynamic Smoking Patterns and Risk of Parkinson Disease and All-Cause Mortality Authors: Ahn, Sung-Ho; Kim, Duk Ho; Park, Jimin; Yoon, Jihyun; Lee, Jun-Hyuk Abstract: Background and ObjectivesSmoking has been reported to be inversely associated with Parkinson disease (PD). However, the higher premature mortality among smokers may act as a competing risk, potentially confounding the inverse association. Because smoking behavior is dynamic, the long-term impact of changes among current smokers remains unclear. We investigated the association between longitudinal changes in smoking status and the risks of PD and all-cause mortality using a competing risk framework and an age-based time scale with left truncation.MethodsThis large-scale retrospective cohort study included current smokers aged 40 years or older who participated in all 3 examination periods of the Korean National Health Screening. Based on longitudinal changes from the initial smoking status to 2 subsequent time points, participants were categorized into 4 groups: persistent smokers, recent quitters, sustained quitters, and relapsed smokers. Cumulative incidence functions for PD were estimated, with all-cause mortality as a competing event, and subdistribution hazard ratios (sHRs) with 95% CIs were obtained using Fine-Gray models.ResultsData were obtained from 410,489 eligible participants (mean age 51.7 +/- 9.0 years; 93.5% male). During a median 9.1-year follow-up, persistent smokers exhibited the lowest risk of PD. Both recent quitters and sustained quitters had higher PD risk than persistent smokers (sHR 1.60 [1.41-1.82] and 1.61 [1.42-1.81]), whereas relapsed smokers did not differ from persistent smokers (sHR 1.05 [0.87-1.28]). For all-cause mortality, recent and sustained quitters had 3% and 17% lower risks, respectively, compared with persistent smokers, whereas relapsed smokers showed no significant difference.DiscussionThe observed pattern of PD risk was suggested to be primarily associated with current smoking status rather than cumulative smoking exposure, as relapsed smokers and recent quitters, who had the same number of smoking time points, showed distinctly different risks. Furthermore, 1 time point (similar to 2 years) of short-term abstinence did not attenuate the protective association. Mortality was lowest in sustained quitters while recent quitters showed a marginal trend toward lower risk, supporting the benefit of early cessation. Interpretation should be cautious because smoking status was assessed at 3 time points, subsequent changes were unknown, and most participants were male.