Abstract TH958: Cardiovascular Risk Stratification Among United States Adults with Metabolic Dysfunction–Associated Steatotic Liver Disease

Background: Metabolic dysfunction–associated steatotic liver disease (MASLD) affects nearly one in three adults in the United States (US), and independently increases the risk of cardiovascular disease (CVD) and CVD-related mortality. However, it is unclear how cardiovascular risk varies with the number of underlying metabolic risk factors. To address this gap, we used the American Heart Association’s PREVENT Equations to estimate 10-year predicted risks of total CVD, atherosclerotic cardiovascular disease (ASCVD), and heart failure (HF) among US adults with MASLD, stratified by the number of cardiometabolic risk factors. Method: We used data from the 2017–March 2020 cycle of the National Health and Nutrition Examination Survey (NHANES) to identify adults aged 30–79 years with MASLD, defined as hepatic steatosis (controlled attenuation parameter ≥280 dB/m) and at least one metabolic risk factor (obesity, type II diabetes or prediabetes, hypertension, hypertriglyceridemia, or low HDL cholesterol). Participants with prevalent cardiovascular disease, viral hepatitis B or C, or excess alcohol intake were excluded. We categorized MASLD by number of risk factors (1–2 [reference], 3, or 4+). Ten-year predicted risks of total CVD were estimated with the PREVENT score. Associations between MASLD category and PREVENT outcomes were assessed using survey-weighted linear regression, adjusting for sociodemographic covariates. Results: The study included 186 participants with MASLD, representing approximately 4.2 million US adults, with a mean (SD) age of 59 (8) years and an equal distribution of females and males ( Table 1 ). A graded increase in PREVENT scores for total CVD, ASCVD, and HF was noted (p<0.05; Table 2 ). Adjusted analyses indicated that participants with ≥4 risk factors had higher predicted risks for total CVD (+8% [95% CI, 4.3–11.5]), ASCVD (+5% [95% CI, 3.3–7.2]), and HF (+6% [95% CI, 3.5–8.6]) compared with individuals with 1–2 risk factors (all p<0.05; Figure 1 ). Conclusion: Ten-year cardiovascular risk increases progressively with cardiometabolic burden among US adults with MASLD; those with ≥4 risk factors demonstrated the highest predicted risk compared with those with 1-2. Comprehensive risk factor management and targeted prevention strategies for those with multiple metabolic risk factors may yield the greatest reduction in cardiovascular risk.