Association of Hematological Biomarkers of Inflammation with 10-Year Major Adverse Cardiovascular Events and All-Cause Mortality in Patients with Metabolic Dysfunction-Associated Steatotic Liver Disease: The ARIC Study

Background: Metabolic dysfunction-associated steatotic liver disease (MASLD) increases the risk of cardiovascular disease and existing evidence indicates that MASLD affects the cardiovascular system through systemic inflammation. Our aim was to assess the association of hematological biomarkers of inflammation with the 10-year risk of major adverse cardiovascular events (MACE) and all-cause mortality in MASLD patients. Methods: A total of 1858 MASLD participants from the Atherosclerosis Risk in Communities cohort study at visit 2 (1990– 1992) were included. A total of 1338 non-MASLD participants were also included in the comparison. At baseline, hematological biomarkers of inflammation such as leukocytes, neutrophils, lymphocytes, monocytes, and C-reactive protein (CRP) were measured. Participants were followed up for MACE and all-cause mortality for a period of 10 years. Multivariate adjusted Cox models were used to estimate hazard ratios (HR). Results: The 10-year MACE was higher in MASLD participants than in non-MASLD participants (20.8% vs 9.3%). Monocytes (HR 1.114, 95% CI, 1.022– 1.216 per 1-SD, P =0.015) and CRP (HR 1.109 95% CI, 1.032– 1.190 per 1-SD, P =0.005) were associated with an increased 10-year risk of MACE, independent of other cardiovascular risk factors. This association was specific to the MASLD population. None of these hematological biomarkers demonstrated a significant association with 10-year all-cause mortality. Conclusion: Increased levels of monocytes and CRP were associated with an increased 10-year risk of MACE in the MASLD population. Hematological biomarkers of inflammation may help identify MASLD populations at higher risk for cardiovascular events. Keywords: MASLD, biomarkers, inflammation, cardiovascular