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

 Hokyou Lee  ;  Tae Seop Lim  ;  Seung Up Kim  ;  Hyeon Chang Kim 
 HEPATOLOGY INTERNATIONAL, Vol.16(6) : 1308-1317, 2022-12 
Journal Title
Issue Date
Female ; Humans ; Liver Cirrhosis / epidemiology ; Liver Diseases* ; Male ; Middle Aged ; Myocardial Infarction* / epidemiology ; Non-alcoholic Fatty Liver Disease* / epidemiology ; Obesity / complications ; Obesity / epidemiology ; Risk Factors
Cardiovascular disease ; Fatty liver ; Metabolic dysfunction-associated fatty liver disease ; Non-alcoholic fatty liver disease ; Subtype
Background and aims: 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.

Methods: 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.

Results: 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.

Conclusion: 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.
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1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Preventive Medicine (예방의학교실) > 1. Journal Papers
Yonsei Authors
Kim, Seung Up(김승업) ORCID logo https://orcid.org/0000-0002-9658-8050
Kim, Hyeon Chang(김현창) ORCID logo https://orcid.org/0000-0001-7867-1240
Lee, Hokyou(이호규) ORCID logo https://orcid.org/0000-0002-5034-8422
Lim, Tae Seop(임태섭) ORCID logo https://orcid.org/0000-0002-4578-8685
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