ArticleAmerican journal of preventive cardiology2026
Risk-associated and clinically informative biomarkers for cardiovascular risk stratification in metabolic dysfunction-Associated steatotic liver disease.
Article in American journal of preventive cardiology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.
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1 citing paper in PubMed.
- Link between Metabolic Dysfunction-Associated Steatotic Liver Disease and Cardiovascular Diseases.Research (Washington, D.C.) · 2026Review
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5 authors.
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Abstract
Background: Metabolic dysfunction-associated steatotic liver disease (MASLD) is associated with atherosclerotic cardiovascular disease (ASCVD), yet the magnitude of cardiovascular risk across various disease labels and the clinical utility of readily available risk-associated markers remains unclear. Methods: We searched PubMed, Embase, Web of Science, and the Cochrane Library from 1 January 2000 to 30 September 2025. Observational studies, as well as randomized trials contributing baseline cross-sectional observational data, were included. We pooled relative effects for (i) 10-year ASCVD high-risk classification as defined by established risk engines and (ii) incident major adverse cardiovascular events (MACE). Heterogeneity ( Results: Fifty-two studies were included. Compared with non-steatotic comparators, steatotic liver disease was associated with a higher overall cardiovascular burden (pooled relative effect 2.02, 95 % CI 1.90-2.14). When stratified by outcome, pooled effects were 1.91 (95 % CI 1.60-2.29) for predicted 10-year ASCVD high-risk classification and 1.74 (95 % CI 1.43-2.12) for incident MACE. Associations were consistent across disease labels, including nonalcoholic fatty liver disease (NAFLD; 1.98, 95 % CI 1.81-2.16), with higher but less precise estimates observed for nonalcoholic steatohepatitis (NASH; 3.60, 95 % CI 1.16-6.04). Readily available biomarkers may help complement established ASCVD risk scores by refining cardiovascular risk stratification in individuals with MASLD. Several readily available markers were informative for cardiovascular risk: Fatty Liver Index (FLI) ≥60 (hazard ratio [HR] 1.61, 95 % CI 1.12-2.11) and ≥30 (HR 1.39, 95 % CI 1.11-1.66); Fibrosis-4 index (FIB-4) ≥1.30 (HR 2.25, 95 % CI 1.84-2.65); blood pressure ≥130/85 mmHg (HR 2.16, 95 % CI 1.81-2.51); triglyceride-glucose index (TyG) >8.716 (HR 1.40, 95 % CI 1.26-1.54); and type IV collagen 7S ≥5 ng/mL (HR 2.37, 95 % CI 1.45-4.29). Compared with controls, MASLD was also associated with an adverse biomarker profile, including higher high-sensitivity C-reactive protein (hs-CRP) (+1.06 mg/L), homeostasis model assessment of insulin resistance (HOMA-IR) (+1.65), alanine aminotransferase (ALT) (+8.89 U/L), aspartate aminotransferase (AST) (+6.10 U/L), gamma-glutamyl transferase (GGT) (+13.23 U/L), total cholesterol (TC) (+9.05 mg/dL), triglycerides (TG) (+48.33 mg/dL), low-density lipoprotein cholesterol (LDL-C) (+8.46 mg/dL), glycated hemoglobin (HbA1c) (+0.43 %), and lower high-density lipoprotein cholesterol (HDL-C) (-8.41 mg/dL). Conclusions: MASLD is associated with an approximate twofold increased risk of cardiovascular events, but this association varies based on population and clinical context. A concise and pragmatic panel-FIB-4, FLI, blood pressure, and triglyceride-glucose index, with type IV collagen 7S where available (and NAFLD-LFS in selected settings)-may complement established ASCVD risk assessment and support earlier, risk-guided prevention in routine MASLD care.
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