Key result
Lean MAFLD is linked to ~2.1-fold higher 1-year eMACE risk vs non-lean MAFLD in CAD.
Why the study?
The prognostic significance of lean metabolic dysfunction-associated fatty liver disease (MAFLD) in patients with obstructive coronary artery disease remained uncertain.
Does the lean MAFLD phenotype (BMI <23 kg/m²) increase the 1-year risk of expanded major adverse cardiovascular events compared to non-lean MAFLD (BMI ≥23 kg/m²) in patients with obstructive coronary artery disease?
Cohort (n=193)
No
Does the lean MAFLD phenotype (BMI <23 kg/m²) increase the 1-year risk of expanded major adverse cardiovascular events compared to non-lean MAFLD (BMI ≥23 kg/m²) in patients with obstructive coronary artery disease?
In patients with obstructive coronary artery disease and MAFLD, a lean phenotype (BMI <23 kg/m²) is independently associated with a more than twofold higher 1-year hazard of expanded major adverse cardiovascular events compared to non-lean MAFLD, largely driven by coronary revascularization.
Background: The prognostic significance of lean metabolic dysfunction-associated fatty liver disease (MAFLD) in patients with obstructive coronary artery disease remains uncertain. We evaluated 1-year cardiovascular outcomes in lean versus non-lean MAFLD. Methods: This prospective observational cohort study included 193 adults with MAFLD and coronary computed tomography angiography (CCTA)-defined obstructive coronary artery disease at Thong Nhat Hospital, Vietnam. Lean MAFLD was defined as a body mass index <23 kg/m² and non-lean MAFLD as a body mass index ≥23 kg/m². The primary outcome was the first expanded major adverse cardiovascular event (eMACE) within 365 days, including ischemia-driven coronary revascularization. Planned first percutaneous coronary intervention (PCI) after baseline CCTA was included. Kaplan-Meier and Cox proportional hazards analyses were performed. Results: During follow-up, 115 patients (59.6%) experienced eMACE. The eMACE rate was higher in lean than in non-lean MAFLD (86.2% vs 54.9%, P=0.002). Among these cases, recorded components were revascularization (108), myocardial infarction (13), unstable angina (26), acute heart failure (1), stroke (0), and cardiovascular death (0); components overlapped. These counts do not establish first-event attribution. Lean MAFLD remained associated with eMACE after adjustment for age, sex, and multivessel coronary artery disease (adjusted HR 2.07, 95% CI 1.32-3.26, P=0.002). Conclusions: Among patients with MAFLD and obstructive coronary artery disease, lean MAFLD was associated with a higher 1-year hazard of eMACE than non-lean MAFLD, after adjustment for age, sex, and multivessel coronary disease. The small lean group and inclusion of planned revascularization limit extrapolation to non-revascularization events, confirmation in larger cohorts is needed.
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Vu et al. (2026) conducted a cohort in Metabolic dysfunction-associated fatty liver disease (MAFLD) and obstructive coronary artery disease (n=193). Lean MAFLD (BMI <23 kg/m²) vs. Non-lean MAFLD (BMI ≥23 kg/m²) was evaluated on First expanded major adverse cardiovascular event (eMACE) within 365 days, including ischemia-driven coronary revascularization, MI, unstable angina, acute heart failure, stroke, and CV death (HR 2.07, 95% CI 1.32-3.26, p=0.002). Lean MAFLD was associated with a higher 1-year risk of eMACE vs non-lean MAFLD in obstructive CAD (86.2% vs 54.9%; adjusted HR 2.07, 95% CI 1.32-3.26, P=0.002).
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