Cardiovascular events and incident diabetes in 220 patients with MASLD according to basal liver fibrosis: a 10-year follow-up historic cohort

Metabolic dysfunction-associated steatotic liver disease (MASLD) patients have a higher incidence of cardiovascular events (CVE) compared to controls. Aim The aim of this study is to analyze association between liver fibrosis with CVE, incident diabetes, and cirrhosis complications. Methods Historic cohort of biopsy-proven MASLD patients, divided into two groups: F0–F2 vs F3–F4 fibrosis. Baseline data included metabolic traits and liver function tests. Patients were contacted and scheduled for laboratory analysis and elastography. Endpoints were (a) CVE, defined as any of acute myocardial infarction, coronary stenting, ischemic cardiopathy, and stroke; (b) incident diabetes; (c) cirrhosis complications. Baseline data were collected at the time of liver biopsy, while follow-up data were recovered through personal interview or medical records. A stepwise logistic regression determined predictive variables for each endpoint. Results Study population included 220 patients with median age 53 years, and 145 were women; baseline fibrosis was F0–F2 in 165 patients and F3–F4 in 55 patients; median follow-up was 9.9 years. A higher percentage of F3–F4 patients had CVE (29.4%) than F0–F2 ones (13.1%) (hazard ratio 2.42; 95% CI: 1.26–4.6; P = 0.008). Incident diabetes occurred in 53.3% of F3–F4 and 20.2% of F0–F2 cohort (hazard ratio 3.04; 95% CI: 1.99–4.86; P < 0.001); cirrhosis complications occurred in 9/55 F3–F4 patients and in 1/165 F0–F2 ones (hazard ratio 26.3; 95% CI: 3.3–208.3; P = 0.002). Multivariate analysis confirmed liver fibrosis as an independent predictor of incident diabetes and cirrhosis complications. CVE were associated with baseline diabetes and aspartate aminotransferase (AST)/alanine aminotransferase (ALT) ratio. Conclusion In a cohort of 220 MASLD patients followed for 9.9 years, baseline F3–F4 was associated with incident diabetes and cirrhosis complications. AST/ALT ratio and diabetes were associated with CVE.