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October 1, 2025Therapeutic Advances in Chronic DiseaseOpen Access

Compared with metabolic healthy lean/normal weight MAFLD, metabolic dysfunctional lean/normal weight MAFLD had the highest risk for high adverse cardiovascular events, followed by metabolic dysfunctional overweight/obese MAFLD (all p<0.05).

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Why the study?

Cardiovascular disease is the leading cause of death in MAFLD, motivating an investigation into CVD risk across MAFLD subgroups.

Does metabolic dysfunction and obesity increase the risk of adverse cardiovascular events in patients with metabolic-associated fatty liver disease?

Population

Chinese health check-up participants with MAFLD across MHL, MHO, MDL, and MDO subgroups

Comparison

MHL vs MHO vs MDL vs MDO subgroups

Design

Prospective cohort study

Key result

Compared with metabolic healthy lean/normal weight MAFLD, metabolic dysfunctional lean/normal weight MAFLD had the highest risk for high adverse cardiovascular events, followed by metabolic dysfunctional overweight/obese MAFLD (all p<0.05).

Authors

YDYao DouJCJiawei CuiQGQi Gu

Discussion

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Overview

MAFLD linked to higher CVD risk especially in metabolic dysfunction subgroups; leaves open targeted screening value in observational cohorts.

Key Points

  • To evaluate atherosclerotic cardiovascular disease risk across subgroups of metabolic-associated fatty liver disease categorized by body weight and metabolic status.
  • Conducted a prospective cohort study of health check-up participants from June 2017 to January 2023 at the Third Hospital of Hebei Medical University in China.
  • Categorized participants into four subgroups: metabolically healthy lean (MHL), metabolically healthy overweight/obese (MHO), metabolically dysfunctional lean (MDL), and metabolically dysfunctional overweight/obese (MDO).
  • Assessed primary prevention risk for high adverse cardiovascular events using the Chinese adult atherosclerotic cardiovascular disease flowchart, adjusting for age, gender, smoking, drinking, and significant liver fibrosis.
  • Subgroup distribution among participants was 0.77% for MHL (n = 185), 10.05% for MHO (n = 2,406), 1.29% for MDL (n = 310), and 16.86% for MDO (n = 4,038).
  • Metabolic-associated fatty liver disease subgroup status was an independent risk factor for high adverse cardiovascular events after multivariable adjustment, with MDL carrying the highest risk, followed by MDO compared to MHL (all p < 0.05).
  • Cardiovascular risk showed no significant difference between MHO and MHL, and stratified analyses by age (65 years) and gender yielded consistent findings.

Study Design

Type

Cohort

Multicenter

No

Structured PICO

Does metabolic dysfunction and obesity increase the risk of adverse cardiovascular events in patients with metabolic-associated fatty liver disease?

P
Population
Chinese adults undergoing health check-ups between June 2017 and January 2023, evaluated for the association between MAFLD subgroups and cardiovascular disease risk.
E
Exposure
Metabolic dysfunction and/or overweight/obesity in the setting of MAFLD (MDL, MDO, MHO subgroups)
C
Comparator
Metabolic healthy lean/normal weight MAFLD (MHL)
O
Outcome
High adverse cardiovascular events (HACE) / atherosclerotic CVD riskcomposite

Main Result

p-value: p=<0.05

In patients with MAFLD, metabolic dysfunction rather than obesity alone drives the increased risk of adverse cardiovascular events, highlighting the importance of metabolic status in risk stratification.

Cite This Study

Dou et al. (2025) conducted a cohort in Metabolic-associated fatty liver disease (MAFLD). Metabolic dysfunctional MAFLD (MDL and MDO) vs. Metabolic healthy lean/normal weight MAFLD (MHL) was evaluated on High adverse cardiovascular events (HACE) (p=<0.05). Compared with metabolic healthy lean/normal weight MAFLD, metabolic dysfunctional lean/normal weight MAFLD had the highest risk for high adverse cardiovascular events, followed by metabolic dysfunctional overweight/obese MAFLD (all p<0.05).

synapsesocial.com/papers/6a8971074c30e1095aec7457https://doi.org/10.1177/20406223251378867
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Comparison of Clinical Characteristics and Outcomes of MAFLD and NAFLD in Chinese Health Examination Populations2023 · 9 citations
  2. 2Cardiometabolic characterization in metabolic dysfunction–associated fatty liver disease2022 · 7 citations
  3. 3The Uncovering of the Hidden Connection Between MAFLD and Cardiovascular Risk2023
  4. 4The <scp>MAFLD</scp> definition identifies three homogenous groups of patients2024 · 8 citations
  5. 5Prevalence of metabolic dysfunction-associated fatty liver disease among health check-up attendees: A retrospective study conducted in Vietnam2025