Kidney Week

Abstract: SA-PO0401

Metabolic Dysfunction-Associated Steatotic Liver Disease and Cardiovascular-Kidney-Metabolic Syndrome Increase the Risk of Major Cardiovascular Events

Session Information

• CKM: Clinical - Epidemiology and Outcomes
  October 24, 2026 | Location: Exhibit Hall A, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Cardiovascular-Kidney-Metabolic Health

• 602 Cardiovascular-Kidney-Metabolic Health: Clinical

Authors

• Tsai, Min Kuang, Taipei Medical University Shuang Ho Hospital Ministry of Health and Welfare, New Taipei, New Taipei City, Taiwan

Min Kuang Tsai, PhD

• Wu, Mei-Yi, Taipei Medical University Shuang Ho Hospital Ministry of Health and Welfare, New Taipei, New Taipei City, Taiwan

Mei-Yi Wu, MD

• Wen, Chi Pang, National Health Research Institutes, Zhunan Township, Taiwan

Chi Pang Wen, MD, DrPH

• Wu, Mai-Szu, Taipei Medical University Shuang Ho Hospital Ministry of Health and Welfare, New Taipei, New Taipei City, Taiwan

Mai-Szu Wu, MD

Background

Metabolic dysfunction–associated steatotic liver disease (MASLD) and cardiovascular–kidney–metabolic (CKM) syndrome are two major and interrelated public health challenges. Although they share common metabolic risk factors and frequently coexist, the extent to which MASLD modifies CKM-related cardiovascular risk and long-term outcomes remains incompletely understood.

Methods

This study was based on a large-scale health screening cohort (N=53,773) in Taiwan from 1994 to 2022, linked to the National Health Insurance Research Database for outcome ascertainment. MASLD was defined as the presence of hepatic steatosis in combination with metabolic dysfunction, including overweight or obesity, type 2 diabetes mellitus, or at least two metabolic abnormalities in individuals without diabetes or obesity. Hepatic steatosis and liver disease severity were assessed using noninvasive indices, including the Fatty Liver Index, FIB-4, and liver enzymes. CKM stages were classified according to established criteria. Cox proportional hazards models were used to estimate hazard ratios for major cardiovascular events, MACE.

Results

Among the study population, 38.7% had MASLD. Using the traditional definition, 28.1% were classified as having NAFLD, of whom 8.7% had NAFLD-related advanced fibrosis. The prevalence of MASLD and NAFLD increased progressively with advancing CKM stages. Across all CKM stages, a clear dose–response relationship was observed between CKM severity and the risk of MACE, with individuals at stage 4 exhibiting more than a fivefold increased risk compared with those at stage 0. Importantly, MASLD consistently amplified cardiovascular risk at every CKM stage. For example, at stage 4, the HR increased from 5.53 in individuals without MASLD to 6.87 in those with MASLD. Further stratification by liver disease severity demonstrated that individuals with NAFLD-related fibrosis had the highest risk of MACE, indicating that advanced liver disease is a critical modifier of cardiovascular risk.

Conclusion

MASLD significantly amplifies CKM-associated cardiovascular risk across all disease stages, with the greatest risk observed in individuals with advanced liver fibrosis. These findings highlight a synergistic interaction between metabolic liver disease and CKM burden, underscoring the importance of integrated risk assessment and early intervention.