Association of VCTE-derived liver parameters and MASLD subtypes with advanced cardiovascular-kidney-metabolic syndrome

Background and aims In cardiovascular-kidney-metabolic (CKM) syndrome, metabolic dysfunction-associated steatotic liver disease (MASLD) is not included in its staging criteria. We aimed to evaluate the associations between vibration-controlled transient elastography (VCTE)-derived liver parameters and advanced CKM stages, and to examine whether the CKM profile differs among MASLD subtypes. Methods VCTE and cardio-metabolic assessments were conducted among individuals enrolled in the New Hong Kong Cardiovascular Risk Factor Prevalence Study (NCRISPS), an ongoing population-based cohort recruiting Chinese residents of Hong Kong SAR between 2019 and 2024. Results Among 3199 eligible participants, 37.2% had MASLD, with 34.4% having MASLD alone and 2.8% due to combined etiology. VCTE-derived controlled attenuation parameter (CAP), liver stiffness (LS), and FibroScan-AST (FAST) score each showed graded associations with advanced CKM stages (all P<0.05). Compared to participants without steatotic liver disease, those with MASLD alone (adjusted OR 1.44, 95% CI 1.07–1.94; P = 0.016) and MASLD due to combined etiology (adjusted OR 2.35, 95% CI 1.22–4.49; P = 0.010) were both associated with significantly higher odds of advanced CKM stages. Conclusions MASLD, with and without combined etiology, was associated with the presence of advanced CKM syndrome. VCTE-derived parameters including CAP, LS, and FAST score were all associated with advanced CKM stages in a graded manner and whether inclusion of these non-invasive markers improves CKM syndrome staging and classification warrants longitudinal evaluation.