Author, Year | Country | MAFLD diagnosis | CVD outcomes | Study population | Study design | Follow-up length | Main findings | Refs. |
---|---|---|---|---|---|---|---|---|
Liu HH et al. 2021 | China | US | MACE defined as CVD death, nonfatal myocardial infarction or coronary revascularizations | 3306 patients with CCS with MAFLD; 3306 age- and sex-matched controls without MAFLD | Matched case–control study | Mean of 4.6 years | CCS patients with MAFLD overlapping with NAFLD or MAFLD-only, had a 1.3-fold and 2.3-fold higher risk of MACE compared with controls (both p < 0.05) | [22] |
Tsutsumi T et al. 2021 | Japan | US | 10-year risk ASCVD either by Framingham risk score or by Suita score | 2306 subjects with fatty liver with health check-up programs | Cohort study | About 10 years | Cumulative incidence of worsening of the Suita score was higher in the MAFLD group than in the NAFLD group. MAFLD, but not NAFLD, was independently associated with higher 10-year ASCVD risk score | [20] |
Kim D et al. 2021 | USA | US | All-cause mortality CVD mortality | 7761 subjects in the NHANES III 1988–94 database | Population-based cohort study | Median of 23 years | Individuals with MAFLD had a 17% higher risk of all-cause mortality (HR 1.17; 95% CI 1.04–1.32). MAFLD was associated with a higher risk of CVD mortality. NAFLD did not increase the risk of all-cause mortality | [30] |
Nguyen VH et al. 2021 | USA | US | All-cause mortality CVD mortality | 2997 subjects with MAFLD and/or NAFLD in the NHANES III 1988–1994 database | Population-based cohort study | Median of 23 years | MAFLD-only status was independently associated with all-cause mortality compared with NAFLD-only status (adjusted HR 2.4; 95% CI, 1.2–4.6) | [29] |
Liu S et al. 2021 | China | US | Subclinical atherosclerosis markers (defined as increased ba-PWV increased CIMT, or microalbuminuria) | 6232 individuals aged 40 years or older | Population-based cohort study | Median of 4.3 years | MAFLD was associated with higher risks of developing subclinical atherosclerosis. Resolution of MAFLD was associated with lower risks of both increased CIMT and ba-PWV | [21] |
Niriella MA et al. 2021 | Sri Lanka | US | Fatal and nonfatal CVD events | 2985 individuals | Population-based cohort study | Follow-up of 7 years | Subjects excluded by the NAFLD definition but captured by the MAFLD definition had substantially higher risk of adverse CVD outcomes than controls | [28] |
Liang Y et al. 2022 | China | US | Nonfatal CVD events (coronary heart disease and stroke) | 6873 middle-aged individuals | Cohort study | Mean of 4.6 years | MAFLD was associated with higher risk of CVD events (HR 1.44; 95% CI, 1.15–1.81). Similar associations were observed for NAFLD | [120] |
Kim H et al. 2022 | Korea | US | 10-year ASCVD risk by 2018 AHA guideline and coronary artery disease by CCTA | 2144 asymptomatic subjects without a prior CVD history with health check-ups | Cross-sectional | None | MAFLD predicted a higher 10-yr ASVD risk and the risk of CCTA-defined coronary artery disease better than NAFLD. NAFLD-only status did not show any association with the 10-year ASCVD risk | [18] |
Lee H et al. 2021 | Korea | ICD-10 codes | Composite CVD outcome, inclusive of myocardial infarction, stroke, heart failure or CVD mortality | ~ 9.5 million subjects undergoing routine NHIS health examinations | Nationwide health screening database | Median of 10.1 years | Change from NAFLD to MAFLD criteria identified a greater number of individuals at risk for CVD events | [14] |
Yoneda M et al. 2021 | Japan | FLI | CVD events (stroke and coronary artery disease) | ~ 4.0 million persons from the Japan Medical Data Center database | Nationwide claims database | 2013–2019 | Rates of CVD events increased similarly with NAFLD and MAFLD definitions | [52] |
Jeong S et al. 2021 | Korean | FLI | CVD events (≥ 2 days of hospitalization due to coronary heart disease) | 333,389 subjects from Korean NHIS database | Nationwide health screening database | Follow-up of 1850,704 person-year | Coexistence of hepatic steatosis and metabolic dysfunction better predicted CVD events than hepatic steatosis or metabolic dysfunction alone | [121] |
Matsubayashi Y et al. 2022 | Japan | FLI | CVD events | 570,426 subjects from a nationwide claims database | Nationwide claims database | Median of 5.2 years | Differentiating metabolic syndrome and/or MAFLD by gender with or without coexisting type 2 diabetes can help accurately identify patients at high CVD risk | [122] |
Noda T et al. 2022 | Japan | FLI | All-cause mortality and CVD re-hospitalization events | 479 patients with ACS | Retrospective cohort study | Median of 1.4 years | Coexistence of MAFLD and reduced physical function tests independently predicted the risk of clinical outcomes | [23] |
Moon JH et al. 2022 | Korea | FLI | All-cause mortality and CVD events | 8919 subjects from the Ansung-Ansan cohort study | Population-based cohort study | Median of 15.7 years | MAFLD predicted the risk of all-cause mortality and CVD events better than NAFLD. Metabolic dysfunction contributed to all-cause mortality (HR 1.51; 95% CI, 1.21 to 1.89) and CVD events (HR 1.27; 95% CI,1.02 to 1.59) | [50] |