Key result
MASLD or MASH was associated with all 14 documented ASCVD events compared with 0 events in individuals with healthy livers (P=0.0001), though 5- and 10-year risk scores did not differ.
Why the study?
The increasing prevalence of obesity, diabetes, and metabolic syndrome in Saudi Arabia has raised concerns about MASLD, MASH, and related cardiovascular complications, prompting comparison of ASCVD occurrence and calculated risk scores against individuals without hepatic steatosis.
Is metabolic dysfunction-associated steatotic liver disease (MASLD) or metabolic steatohepatitis (MASH) associated with a higher occurrence of atherosclerotic cardiovascular disease (ASCVD) events and higher calculated risk scores compared to healthy livers in adults undergoing abdominal imaging?
Cross-Sectional (n=532)
No
Is metabolic dysfunction-associated steatotic liver disease (MASLD) or metabolic steatohepatitis (MASH) associated with a higher occurrence of atherosclerotic cardiovascular disease (ASCVD) events and higher calculated risk scores compared to healthy livers in adults undergoing abdominal imaging?
In a Saudi tertiary care cohort, ASCVD events occurred exclusively in patients with MASLD or MASH compared to those with healthy livers, highlighting a potential association between fatty liver disease and cardiovascular events despite similar calculated 5- and 10-year risk scores.
Should not yet alter ASCVD risk assessment or screening; leaves open whether steatotic liver disease adds predictive value beyond standard scores.
BACKGROUND: Obesity, diabetes, and metabolic syndrome are becoming increasingly prevalent in Saudi Arabia, and therefore, raising concerns about metabolic dysfunction-associated steatotic liver disease (MASLD), metabolic steatohepatitis (MASH), and related cardiovascular complications. This study compared the occurrence of atherosclerotic cardiovascular disease (ASCVD) and calculated risk scores in patients with MASLD or MASH versus those with no imaging evidence of hepatic steatosis (“Healthy Liver” group). MATERIALS AND METHODS: We retrospectively reviewed medical records of adults aged ≥18 years who had undergone abdominal imaging, including ultrasound, computed tomography, or magnetic resonance imaging between 2018 and 2022 at a tertiary care hospital in Riyadh. Data extracted included demographic characteristics, medical history, laboratory results, and results of imagaing reports. Data was analyzed using Stata; Fisher's exact test was used to test for association between liver health status and ASCVD events whereas t-test compared ASCVD risk scores between groups. RESULTS: The study included 532 patients with a mean age of 53.5 years, most of whom were women (64.3%), Saudi nationals (78.0%), and overweight or obese (50.4%). Common comorbidities found in them included dyslipidemia (42.9%), hypertension (35.2%), diabetes (34.2%), and hypothyroidism (21.4%). Frequently prescribed medications were statins (39.5%), antihypertensive agents (36.1%), and antidiabetic therapies (38.9%). All 14 documented ASCVD events occurred in patients with MASLD or MASH, while no events were observed in individuals with healthy livers ( P = 0.0001). However, 5-year and 10-year ASCVD risk scores did not differ significantly between groups. CONCLUSION: The ASCVD events were observed exclusively in MASLD/MASH patients, suggesting a potential association. Given the small event burden and retrospective design, findings are exploratory. Locally relevant Saudi data highlight the need for larger prospective studies to validate cardiovascular implications of fatty liver disease.
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Almanea et al. (2026) conducted a cross-sectional in Metabolic dysfunction-associated steatotic liver disease (MASLD) or metabolic steatohepatitis (MASH) (n=532). Metabolic dysfunction-associated steatotic liver disease (MASLD) or metabolic steatohepatitis (MASH) vs. No imaging evidence of hepatic steatosis (Healthy Liver group) was evaluated on Atherosclerotic cardiovascular disease (ASCVD) events (p=0.0001). MASLD or MASH was associated with all 14 documented ASCVD events compared with 0 events in individuals with healthy livers (P=0.0001), though 5- and 10-year risk scores did not differ.
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