Measures of comorbid cardiometabolic burden and cardiovascular disease risk in people with MRI-confirmed steatotic liver disease: a prospective cohort study

TL;DR

This study finds that the number of cardiometabolic risk factors is a strong predictor of cardiovascular disease and mortality in people with fatty liver disease.

Contribution

The study demonstrates that counting cardiometabolic risk factors is as effective as complex patterns for predicting cardiovascular risk in steatotic liver disease.

Findings

Higher cardiometabolic risk factor count is independently linked to increased cardiovascular disease and mortality risk.

Three distinct cardiometabolic risk factor patterns were identified but did not improve risk prediction beyond simple counts.

Adjusting for risk factor count reduced the predictive value of complex CMRF patterns.

Abstract

Steatotic liver disease (SLD) is commonly associated with higher burden of cardiometabolic risk factors (CMRFs). This study aimed to examine the associations between CMRF count, patterns and risk of cardiovascular disease.

We included 10,121 UK Biobank participants (39% women) with MRI-confirmed liver steatosis. Latent class analysis was used to derive CMRF patterns based on 5 CMRFs (obesity, diabetes, hypertension, high triglycerides and low HDL). Cox models were used to estimate associations between CMRF count and patterns with incidence and mortality of cardiovascular disease (CVD), and all-cause mortality.

Approximately 95% of SLD participants had ≥ 2 CMRFs. During a median follow-up of 4.9 years, 268 CVD events and 212 deaths were recorded. Higher CMRF count was independently associated with elevated risk of CVD (HR per each additional CMRF: 1.23 (1.08, 1.40)), CVD mortality (1.47 (1.07, 2.02)), and all-cause mortality (1.25 (1.08, 1.44)). Three distinct CMRF patterns were identified, reflecting varying levels of CMRF burden and demographic characteristics. While certain patterns with high CMRF burden were associated with increased CVD risk, the associations were substantially attenuated after adjusting for CMRF count.

CMRF burden is a key determinant of cardiovascular risk in people with SLD, but data-driven CMRF patterns do not improve risk prediction beyond simple counts. CMRF count remains a practical measure of cardiometabolic burden.

The online version contains supplementary material available at 10.1186/s12933-026-03088-1.

Figures