Stratified cardiovascular risk in patients with metabolic dysfunction-associated steatotic liver disease (MASLD): impact of varying metabolic risk factor burden.

Background: Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD) is a spectrum of hepatic disorders that are closely linked to metabolic risk factors. This study aimed to investigate the stratified cardiovascular risk in patients with MASLD based on varying metabolic risk burdens.

Methods: In a cross-sectional analysis, 357 patients with MASLD were classified into three subtypes based on the number of metabolic conditions used for diagnosis: subtype 1 with one metabolic risk factor (n = 110), subtype 2 with two (n = 161), and subtype 3 with three risk factors (n = 86). Clinical parameters, liver enzymes, lipid profiles, and 10-year risk of Atherosclerotic Cardiovascular Disease (ASCVD) were compared among subtypes.

Results: The prevalence of diabetes and hypertension increased significantly across subtypes, with subtype 3 showing the highest burden of cardiovascular risk factors (100% diabetes, 43% hypertension). Cardiovascular risk was elevated in subtype 3 (mean ASCVD 0.112 ± 0.108, p < 0.001). Multivariate analysis identified subtype 3 (OR = 7.812, 95% CI 1.980-30.819, p = 0.003), men sex (OR = 33.549, 95% CI 11.814-95.269, p < 0.001), and age (OR = 1.171, 95% CI 1.116-1.229, p < 0.001) as independent predictors of intermediate to high cardiovascular risk.

Conclusion: The metabolic burden in patients with MASLD significantly stratified cardiovascular risk. Patients with the highest metabolic dysfunction are at increased risk of cardiovascular events, underscoring the need for targeted cardiovascular prevention strategies.