Association Between Liver Stiffness Severity and Atherosclerotic Cardiovascular Disease Risk Among Diabetic and Non-Diabetic Patients with Metabolic Dysfunction-Associated Fatty Liver Disease.
DOI:
https://doi.org/10.58889/PJCVI.6.1.83.96Keywords:
Metabolic Dysfunction-Associated Fatty Liver Disease, Type 2 Diabetes Mellitus, Liver Fibrosis, Transient Elastography, Cardiovascular Risk, ASCVDAbstract
Background: Metabolic dysfunction-associated fatty liver disease (MAFLD) is closely linked to type 2 diabetes mellitus (T2DM) and heightened cardiovascular risk. Liver fibrosis, a marker of disease progression, has also been associated with adverse cardiovascular outcomes. This study compared liver stiffness, hepatic steatosis, and atherosclerotic cardiovascular disease (ASCVD) risk between diabetic and non-diabetic MAFLD patients and identified factors independently associated with elevated ASCVD risk.
Methodology: A hospital-based comparative cross-sectional study was conducted at Liaquat National Hospital, Karachi, Pakistan. A total of 240 adults with MAFLD confirmed by transient elastography (FibroScan®) were enrolled, including 120 diabetic and 120 non-diabetic participants. Hepatic steatosis was assessed using the controlled attenuation parameter (CAP), while liver fibrosis was measured by liver stiffness measurement (LSM). Demographic, anthropometric, biochemical, and cardiometabolic characteristics were compared. ASCVD risk was estimated using the PREVENT risk calculator.
Results: Diabetic participants were older and had higher HbA1c, ALT, total cholesterol, LDL/HDL ratio, serum creatinine, and ASCVD scores (all p<0.05). Advanced fibrosis was more frequent among diabetics (10.0% vs. 1.7%; p=0.015). Participants with high ASCVD risk exhibited higher total cholesterol, LDL/HDL ratio, CAP values, and fibrosis severity. Multivariable analysis identified age (OR=1.22; 95% CI: 1.13–1.32; p<0.001) and LDL/HDL ratio (OR=2.41; 95% CI: 1.47–3.97; p=0.001) as independent predictors. Diabetes, BMI, ALT, and LSM were not independently associated.
Conclusion: MAFLD patients with diabetes have worse metabolic profiles and greater fibrosis, but elevated ASCVD risk is primarily driven by age and atherogenic dyslipidemia rather than diabetes or liver stiffness, highlighting the need for comprehensive cardiometabolic risk assessment.
