Association between high-risk metabolic dysfunction-associated steatohepatitis and ischemic heart disease: a nationally representative study

Background The relationship between metabolic dysfunction-associated steatohepatitis (MASH) and ischemic heart disease (IHD) remains incompletely understood. This study investigated this association in the U.S. adults utilizing the FibroScan-AST (FAST) score, a validated non-invasive tool for identifying high-risk MASH. Methods This cross-sectional study included 3,696 adults in the 2017–2018 National Health and Nutrition Examination Survey. We defined high-risk MASH as FAST score ≥ 0.35. We performed logistic regression to investigate the association between high-risk MASH and prevalent IHD. FAST was calculated by liver stiffness measurement (LSM), controlled attenuation parameter (CAP), and aspartate aminotransferase (AST). Results The prevalence of IHD was significantly higher in the high-risk MASH group than in the non-high-risk group (10.5% vs. 5.8%). Both LSM (adjusted odds ratio (aOR) 1.84, 95% CI 1.28–2.65) and CAP (aOR 3.06, 95% CI 1.32–7.12) were independently associated with IHD after adjustment, whereas AST did not demonstrate a significant association (aOR 0.83, 95% CI 0.48–1.43). High-risk MASH was independently associated with IHD (aOR: 2.08; 95% CI: 1.18–3.65). Subgroup analysis suggested a potential sex-specific interaction (P for interaction = 0.035), with a pronounced association in males (aOR: 2.51; 95% CI: 1.32–4.75) but was not statistically significant in females (aOR: 0.36, 95% CI 0.07–1.27). Conclusion High-risk MASH defined by the FAST score is independently associated with prevalent IHD in the U.S. population. Future prospective cohort studies are warranted to validate whether intervation of high-risk MASH improves cardiovascular outcomes.