Polyvascular subclinical atherosclerosis differs across metabolic dysfunction-associated fatty liver disease subtypes: a community-based cross-sectional study

BACKGROUND AND AIM: Data on the link between metabolic dysfunction-associated fatty liver disease (MAFLD) and subclinical atherosclerosis (SA) assessed at multiple vascular sites are limited.This study aimed to evaluate the association of MAFLD and its subtypes with multiple territorial extents of SA. METHODS AND RESULTS: This cross-sectional study included 3,539 health check-up participants. All subjects were categorized into four groups: non-MAFLD, diabetes mellitus (DM)-MAFLD, overweight/obese (OW)-MAFLD and lean-MAFLD. Polyvascular plaques were assessed, with vascular ultrasound for the carotid, subclavian, abdominal aorta and iliofemoral arteries (4 sites) and brachial-ankle pulse wave velocity for central and peripheral muscular artery stiffness (1 site). The extent of the SA was defined according to the number of these five vascular sites affected. Compared with those in the non-MAFLD group, the odds ratios (95% confidence intervals) for MAFLD with a greater number of plaques were 1.69 (1.41-2.02), 1.65 (1.41-1.93), 1.75 (1.45-2.11) and 1.57 (1.32-1.87) in the carotid, subclavian, abdominal aorta and iliofemoral arteries, respectively; greater artery stiffness was 1.96 (1.63-2.35) in the central and peripheral muscular arteries. The extent of polyvascular SA showed the same pattern. Participants with lean-MAFLD or DM-MAFLD had a greater extent of focal (1 site affected) and multiterritorial (≥2 sites affected) SA than those with OW-MAFLD did. Additionally, the presence of liver fibrosis was significantly associated with increased multiterritorial SA risk in each MAFLD subtype. CONCLUSION: Polyvascular SA differed across MAFLD subtypes. Classifying MAFLD subtypes on the basis of metabolic phenotypes and liver fibrosis might aid in cardiovascular risk stratification.