Cardiometabolic burden increases CVD and death risk in MASLD
In 72,922 adults with MASLD, each additional cardiometabolic risk factor raised hazard ratios for incident CVD to 1.17 and subsequent death to 1.13.
A prospective cohort study tracked 72,922 UK adults with metabolic dysfunction-associated steatotic liver disease over a median follow-up of 15.9 years. Researchers assessed cardiometabolic burden using risk factor counts and a weighted score, modeling transitions to incident cardiovascular disease (CVD), death without CVD, and death after CVD.
During follow-up, 15,352 participants developed CVD, 4,273 died without CVD, and 4,228 died after CVD. Each additional risk factor increased risks of incident CVD (HR 1.17), death without CVD (HR 1.09), and death after CVD (HR 1.13). Associations were more pronounced in participants under 60 years. Circulating inflammatory markers mediated under 3% of the associations, whereas smoking and drinking status showed larger contributions.
Why it matters
The findings highlight how accumulating metabolic dysfunction accelerates vascular disease and mortality trajectories, especially earlier in adulthood. Mapping discrete transition states clarifies how metabolic pathology compounds across chronological age to erode overall healthspan.
Caveats
Because this study is observational, it cannot establish direct causation between cardiometabolic risk factors and disease transitions. The findings are also based solely on a cohort of UK adults, which may limit generalizability to other populations.
The paper
Associations of cardiometabolic burden with cardiovascular disease-death transitions in metabolic dysfunction-associated steatotic liver disease: a prospective cohort study using multistate analysis
Cui C, Zhao Y, Zhang G et al.
Frontiers in Nutrition · 18 Sep 2026
