# Outcome-Specific Cardiovascular and Hypertensive Risk Profiles in Metabolic Dysfunction-Associated Steatotic Liver Disease: Insights From a Competing Risk Cohort Analysis

## TL;DR

This study finds that MASLD significantly increases cardiovascular disease risk but not hypertension, suggesting the need for targeted prevention strategies.

## Contribution

The study reveals outcome-specific risk profiles of MASLD for cardiovascular disease versus hypertension using competing risk analysis.

## Key findings

- MASLD significantly increases cardiovascular disease risk with a dose-dependent effect and stronger associations in younger adults.
- MASLD is not associated with incident hypertension, showing divergent risk profiles.
- MASLD accounts for 17% of all cardiovascular disease events in the cohort.

## Abstract

Metabolic dysfunction–associated steatotic liver disease (MASLD) is a cardiovascular risk factor affecting one in four adults globally. However, it remains unclear whether MASLD uniformly elevates risk across cardiometabolic outcomes. We investigated the outcome-specific associations of MASLD, incident cardiovascular disease (CVD), and hypertension (HTN) in a large Asian cohort.

We analyzed 24,384 adults (median age 51.4 years; 51.2% women) enrolled in a retrospective Japanese health-screening program (2007–2022). MASLD was diagnosed based on the criteria of ultrasonography-confirmed hepatic steatosis and metabolic dysfunction. Primary outcomes were major adverse cardiovascular events and new-onset arterial HTN. We applied time-dependent Cox regression, multistate modeling, and Fine-Gray competing risk analysis over 127,419 person-years (median follow-up: 5.2 years).

Baseline MASLD prevalence was 23.8%. MASLD significantly increased the risk of CVD (adjusted hazard ratio: 1.83; 95% confidence interval: 1.63–2.07; P < .001), with a dose-dependent effect and stronger associations in younger adults. In contrast, MASLD was not associated with incident arterial HTN (hazard ratio: 1.02; 95% confidence interval: 0.95–1.09; P = .634). Competing risk analysis confirmed this divergence (interaction P < .001). MASLD accounted for 17.0% of all CVD events (population-attributable risk). Multistate models showed that MASLD preferentially progressed to CVD rather than HTN.

MASLD substantially increased cardiovascular risk but showed minimal association with HTN. These findings challenge the assumption of a uniform cardiometabolic risk in MASLD and underscore the need for outcome-specific risk stratification and targeted CVD prevention in patients with MASLD.