CHAIN Cohort: Prospective Multicenter Study of MASLD With Serial Liver Stiffness Assessments in Cardiovascular Care

Metabolic dysfunction-associated steatotic liver disease (MASLD) is highly prevalent among patients with cardiovascular disease but remains underrecognized in routine cardiology practice. To address the limited prospective evidence on its progression and clinical impact, we established the CHAIN cohort, a prospective multicenter study enrolling approximately 15 000 adults undergoing coronary evaluation across 40 tertiary hospitals in China. Baseline assessment includes comprehensive cardiometabolic profiling and vibration-controlled transient elastography for evaluation of liver fibrosis and steatosis. Participants will undergo long-term follow-up with repeated liver assessments every 6-12 months. Primary outcomes include liver-related events and major adverse cardiovascular events, while secondary outcomes include longitudinal changes in liver fibrosis and steatosis and their associations with cardiometabolic risk factors and clinical outcomes. This cohort will provide longitudinal evidence to support risk stratification and integrated heart-liver management in cardiovascular care.