Metabolic dysfunction associated fatty liver disease identifies subjects with cardiovascular risk better than nonalcoholic fatty liver disease

Cardiovascular disease (CVD) is the main cause of mortality in subjects with non-alcoholic fatty liver disease (NAFLD). We investigated the association between CVD risk and metabolic dysfunction associated fatty liver disease (MAFLD) or NAFLD and the influence of significant liver fibrosis on the CVD risk.Subjects who underwent a comprehensive medical check-up were recruited (2014-2019). Significant liver fibrosis was defined using NAFLD fibrosis score, fibrosis-4 index, aspartate aminotransferase to platelet ratio index, or FibroScan-AST score. High probability of atherosclerotic CVD (ASCVD) was defined as ASCVD risk score10%.Of the study population (n=78,762), 27,047 (34.3%) and 24,036 (30.5%) subjects had MAFLD and NAFLD, respectively. A total of 1,084 (4.0%) or 921 (3.8%) subjects had previous CVD history in MAFLD or NAFLD subgroup, respectively. The previous CVD history and high probability of ASCVD were significantly higher in MAFLD or NAFLD subgroup with significant liver fibrosis than in the other groups (all P0.001). In multivariable analysis, MAFLD was independently associated with previous CVD history after adjusting for confounders (adjusted odds ratio [aOR]=1.10, P=0.038), whereas NAFLD was not (all P0.05). MAFLD (aOR=1.40) or NAFLD (aOR=1.22) was independently associated with high probability of ASCVD after full adjustment, respectively (all P0.001). Significant liver fibrosis was independently associated with previous CVD history and high probability of ASCVD after adjustment in MAFLD or NAFLD subgroup, respectively (all P0.05).MAFLD might better identify subjects with CVD risk than NAFLD. Fibrosis assessment might be helpful for detailed prognostication in subjects with MAFLD.