Abstract Fri148: Silent Threats: The Growing Intersection of Nonalcoholic Steatohepatitis (NASH) and Cardiovascular Disease (CVD) Mortality in America (1999-2023)

Introduction: Nonalcoholic steatohepatitis (NASH) is a silent driver of rising cardiovascular disease (CVD) mortality in the U.S., highlighting a critical yet overlooked liver-heart connection. Research Question: How have NASH-related CVD mortality trends evolved over 25 years in the U.S.? Aims: To evaluate disparities and trends in mortality by age, sex, race/ethnicity, and geographic region. Methods: Age-adjusted mortality rates (AAMRs) per 100,000 in adults (25+) were obtained from CDC WONDER using ICD codes for NASH and CVD. Joinpoint regression estimated Annual Percent Change (APC) and Average APC (AAPC), with significance at p<0.01. Results: From 1999 to 2023, 473,748 NASH-related CVD deaths occurred, primarily in hospitals (52.8%) and private residences (27.7%). AAMR increased from 7.7 (1999) to 11.5 (2023) with an AAPC of 1.7% (p<0.000001). Men had higher AAMRs than women (11.2 vs. 5.7), but women experienced a steeper rise (AAPC: 2.5%, p<0.000001). Older adults had the highest AAMR (22.6) and the sharpest increase (AAPC: 2.5%, p<0.000001) compared to middle-aged and younger adults. Racially, NH American Indians had the highest AAMR (17.5) and steepest rise (AAPC: 3.0%, p<0.000001). The West had the highest AAMR (9.5), while the South showed the fastest increase (AAPC: 2.3%, p<0.000001). Among states, AAMRs ranged from 17.0 (Oklahoma) to 6.4 (Utah). Urban areas accounted for 66.3% of deaths, while rural areas had slightly higher AAMRs (7.9 vs. 7.8). Conclusion: Marked disparities in NASH-related CVD mortality persist among adults, highlighting the need for targeted interventions, particularly for elderly women, NH American Indians, urban populations, and residents of the Southern U.S.