Sustained cardiovascular risk factor control is associated with reduced metabolic dysfunction-associated steatotic liver disease risk in SLE.

Objectives: Patients with SLE have a higher prevalence of cardiometabolic risk factors, metabolic syndrome and cardiovascular disease than the general population. The metabolic dysfunction-associated steatotic liver disease (MASLD), a new term for non-alcohol-related fatty liver disease, has been recognized as an independent predictor of cardiovascular events in the general population. However, the prevalence and associations of MASLD in SLE are uncertain. We aimed to investigate the potential association between MASLD and traditional and disease-related cardiovascular risk factors (CVRFs) in SLE.

Methods: Patients with SLE and age- and sex-matched healthy control (HCs) who completed a 10-year carotid/femoral ultrasound follow-up examination were invited to undergo transient liver elastography (TEA) to assess MASLD prevalence based on international consensus criteria. Multivariate regression models examined associations between MASLD and the CVRF burden in past 10 years, including traditional and disease-related CVRFs, and atherosclerotic plaque progression.

Results: TEA was performed in 77 SLE patients (median age: 53 years) and 45 age/sex-matched HCs with 10-year follow-up; 40% of patients and 44% of HCs met criteria for MASLD. In SLE, MASLD risk was reduced by 55% (odds ratio [OR]: 0.45, P = 0.021) for each additional sustainedly achieved traditional CVRF target (blood pressure, lipids, smoking, physical activity, or body weight). Patients with femoral plaque progression and consistent IgG anti-beta2glycoprotein I antibody positivity over the past 10 years had a 3.6-fold (OR: 3.62, P = 0.047) and 6.6-fold (OR: 6.58, P = 0.021) higher risk for MASLD, respectively.

Conclusion: Femoral plaque progression and persistent IgG anti-beta2 glycoprotein I antibody positivity are independently associated with MASLD in SLE, while MASLD risk is halved for each additional CVRF target sustainedly attained.