Abstract MPTH69: Metabolic Dysfunction-Associated Steatotic Liver Disease Across the Cardiovascular-Kidney-Metabolic Spectrum: Insights from the CARDIA Study

Background: The prevalence and prognostic impact of metabolic dysfunction-associated steatotic liver disease (MASLD), overall and across the cardiovascular-kidney-metabolic (CKM) spectrum, is uncertain. Methods: In the prospective Coronary Artery Risk Development in Young Adults (CARDIA) study, abdominal computed tomography was performed at a follow-up examination in 2010. MASLD was defined as hepatic steatosis (≤51 Hounsfield units) and ≥1 cardiometabolic criteria, without other causes of hepatic steatosis. The association between MASLD (vs. no MASLD) and clinical outcomes was evaluated. Subgroup analyses were repeated by CKM stage. Results: Among 2,600 participants with sufficient data (mean age, 50±10 years), 89% had CKM syndrome stage ≥1 ( Figure, A ); 24% had MASLD, with higher prevalence at higher CKM syndrome stages ( Figure, B ). After covariate adjustment, MASLD was associated with a higher rate of all-cause death (aHR, 1.90; 95% CI, 1.22-2.98), without heterogeneity across CKM stages ( P interaction =0.78) ( Figure, C ). MASLD was associated with a higher rate of incident cardiovascular events (aHR, 1.81; 95% CI, 1.23-2.65), observed primarily in those with CKM stages 0-1 ( P interaction =0.032) ( Figure, C ). Conclusions: MASLD impacted 1 in 4 middle-aged adults and was associated with cardiovascular and mortality events, particularly at earlier CKM stages. These findings suggest early MASLD recognition and intervention across the CKM spectrum may reduce long-term adverse outcomes.