Comparative Associations of Nonalcoholic Fatty Liver Disease and Metabolic Dysfunction–Associated Fatty Liver Disease With Coronary Artery Calcification: A Cross-Sectional and Longitudinal Cohort Study

Abstract

Background: In cross-sectional and retrospective cohort studies, we examined comparative associations between nonalcoholic fatty liver disease (NAFLD) and metabolic dysfunction–associated fatty liver disease (MAFLD) and risk of having or developing coronary artery calcification (CAC). Methods: Participants who had health examinations between 2010 and 2019 were analyzed. Liver ultrasonography and coronary artery computed tomography were used to diagnose fatty liver and CAC. Participants were divided into a MAFLD and no-MAFLD group and then NAFLD and no-NAFLD groups. Participants were further divided into no fatty liver disease (reference), NAFLD-only, MAFLD-only, and both NAFLD and MAFLD groups. Logistic regression modeling was performed. Cox proportional hazard model was used to examine the risk of incident CAC in participants without CAC at baseline and who had at least two CAC measurements. Results: In cross-sectional analyses, 162 180 participants were included. Compared with either the no-NAFLD or no-MAFLD groups, the NAFLD and MAFLD groups were associated with a higher risk of prevalent CAC (NAFLD: adjusted odds ratio [OR], 1.34 [95% CI, 1.29–1.39]; MAFLD: adjusted OR, 1.44 [95% CI, 1.39–1.48]). Among the 4 groups, the MAFLD-only group had the strongest association with risk of prevalent CAC (adjusted OR, 1.60 [95% CI, 1.52–1.69]). Conversely, the NAFLD-only group was associated with a lower risk of prevalent CAC (adjusted OR, 0.76 [95% CI, 0.66–0.87]). In longitudinal analyses, 34 233 participants were included. Compared with either the no-NAFLD or no-MAFLD groups, the NAFLD and MAFLD groups were associated with a higher risk of incident CAC (NAFLD: adjusted hazard ratio, 1.68 [95% CI, 1.43–1.99]; MAFLD: adjusted hazard ratio, 1.82 [95% CI, 1.56–2.13]). Among these 4 groups, the MAFLD-only group had the strongest associations with risk of incident CAC (adjusted hazard ratio, 2.03,[95% CI, 1.62–2.55]). The NAFLD-only group was not independently associated with risk of incident CAC (adjusted hazard ratio, 0.88 [95% CI, 0.44–1.78]) Conclusions: Both NAFLD and MAFLD are significantly associated with an increased prevalence and incidence of CAC. These associations tended to be stronger for MAFLD.

An international multidisciplinary consensus statement on MAFLD and the risk of CVD

“…Using the Kanbguk Samsung Health Study cohort database, Sung et al reported that both NAFLD and MAFLD were associated with higher risk of developing incident CAC, even after adjusting for age, sex, educational level, smoking, physical activity, pre-existing coronary artery disease, plasma low-density lipoprtoein (LDL)-cholesterol concentrations, or use of lipid-lowering agents. However, these associations were stronger for MAFLD [ 57 ].…”

Liver Fibrosis Scores and Coronary Artery Disease: Novel Findings in Patients with Metabolic Dysfunction-Associated Fatty Liver Disease

“…It has been recognized as the most rapidly increasing cause of liver-related mortality for several decades and affects nearly a quarter of the adults in the general population. [1][2][3] The definition of nonalcoholic fatty liver disease (NAFLD) has been used for decades, excluding viral hepatitis, autoimmune diseases, and heavy drinking as the underlying cause of the disease. However, this definition does not accurately reflect the contribution of systemic metabolic dysregulation to liver diseases.…”

Hs-CRP is associated with Heart Failure Hospitalization in Patients with MAFLD and Normal LVEF Undergoing Coronary Angiography

“…9 Despite a normal left ventricular ejection fraction (LVEF), HFpEF is a common chronic cardiac condition globally, where metabolic dysfunction (e.g., obesity and type 2 diabetes) and low-grade chronic inflammation may contribute importantly to its pathogenesis. [10][11][12] HFpEF is associated with a substantially higher risk of adverse cardiovascular events and all-cause mortality. [10][11][12] Empiric evidence suggests that the unifying link between MAFLD and HFpEF is low-grade chronic inflammation, which may adversely affect cardiomyocyte function.…”

“…[10][11][12] HFpEF is associated with a substantially higher risk of adverse cardiovascular events and all-cause mortality. [10][11][12] Empiric evidence suggests that the unifying link between MAFLD and HFpEF is low-grade chronic inflammation, which may adversely affect cardiomyocyte function. [13][14][15][16] This low-grade inflammatory state is characterized by an increase in various biomarkers in the bloodstream.…”