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

doi:10.1007/s12072-022-10407-7

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

Research output: Contribution to journal › Article › peer-review

4 Citations (Scopus)

Abstract

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.

Original language	English
Pages (from-to)	1308-1317
Number of pages	10
Journal	Hepatology International
Volume	16
Issue number	6
DOIs	https://doi.org/10.1007/s12072-022-10407-7
Publication status	Published - 2022 Dec

Bibliographical note

Funding Information:
This study was supported by the Technology Innovation Program (20013712) funded by the Ministry of Trade, Industry and Energy (MOTIE, Korea) and by a new faculty research seed money grant of Yonsei University College of Medicine (2022-32-0090). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Publisher Copyright:
© 2022, Asian Pacific Association for the Study of the Liver.

All Science Journal Classification (ASJC) codes

Hepatology

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1007/s12072-022-10407-7

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@article{fa9b21d7a77a41c9b12480deb91b4dde,

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

abstract = "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.",

author = "Hokyou Lee and Lim, {Tae Seop} and Kim, {Seung Up} and Kim, {Hyeon Chang}",

note = "Funding Information: This study was supported by the Technology Innovation Program (20013712) funded by the Ministry of Trade, Industry and Energy (MOTIE, Korea) and by a new faculty research seed money grant of Yonsei University College of Medicine (2022-32-0090). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Publisher Copyright: {\textcopyright} 2022, Asian Pacific Association for the Study of the Liver.",

year = "2022",

month = dec,

doi = "10.1007/s12072-022-10407-7",

language = "English",

volume = "16",

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journal = "Hepatology International",

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T1 - Long-term cardiovascular outcomes differ across metabolic dysfunction-associated fatty liver disease subtypes among middle-aged population

AU - Lee, Hokyou

AU - Lim, Tae Seop

AU - Kim, Seung Up

AU - Kim, Hyeon Chang

N1 - Funding Information: This study was supported by the Technology Innovation Program (20013712) funded by the Ministry of Trade, Industry and Energy (MOTIE, Korea) and by a new faculty research seed money grant of Yonsei University College of Medicine (2022-32-0090). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Publisher Copyright: © 2022, Asian Pacific Association for the Study of the Liver.

PY - 2022/12

Y1 - 2022/12

N2 - 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.

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

Abstract

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