Long‐term risk of cardiovascular disease associated with MASLD and different cardiometabolic risk factors in IBD patients: A prospective cohort study

Abstract Background To examine the cardiovascular disease (CVD) risks associated with metabolic dysfunction‐associated steatotic liver disease (MASLD) and different numbers of cardiometabolic risk factors (CMRFs) in patients with inflammatory bowel disease (IBD) based on a long‐term prospective cohort. Methods Prevalent IBD patients at baseline who were free of CVD, cancer, alcoholic liver disease, cancer and hepatitis B/C virus seropositive were included (N = 4204). MASLD, MASLD subtypes [pure MASLD, MASLD with increased alcohol intake (MetALD)], lean/non‐lean MASLD and CMRFs at baseline were defined according to the latest criteria proposed by AASLD and EASL. The primary outcome was incident CVD, including ischaemic heart disease (IHD), heart failure (HF) and stroke. Multivariable Cox proportional hazard models were used to estimate the relationship. Results Overall, 1528 (36.4%) were diagnosed with MASLD at baseline. During a median of 13.1‐year follow‐up, 503 incident CVDs were identified. Compared with IBD‐only, IBD‐MASLD patients had an increased risk of CVD (HR = 1.77, 95%CI: 1.26–2.49), especially in those with MetALD (HR = 2.34, 1.34–4.11) and lean MASLD (HR = 2.30, 1.13–4.66). As the number of CMRFs increased, the risks of CVD were significantly increased ( p trend <0.001), with a 116% and 92% excess risk in MASLD with 3 CMRFs (HR = 2.16, 1.48–3.15) and ≥4 CMRFs (HR = 1.92, 1.27–2.91). Similar excess risk of incident IHD and HF was observed in IBD‐MASLD, either pure MASLD or MetALD, as well as lean/non‐lean MASLD. Conclusions MASLD is associated with increased CVD risk in IBD patients, with greater risk as number of CMRFs increased and evidently higher risk in MetALD and lean MASLD patients.