Measures of comorbid cardiometabolic burden and cardiovascular disease risk in people with MRI-confirmed steatotic liver disease: a prospective cohort study
File(s)
Published version
Author(s)
Feng, Qi
Manousou, Pinelopi
Izzi-Engbaeya, Chioma N
Woodward, Mark
Type
Journal Article
Abstract
Background: Steatotic liver disease (SLD) is commonly associated with higher burden of cardiometabolic risk factors (CMRFs). This study aimed to examine the associations between CMRF count, patterns and risk of cardiovascular disease.
Methods: We included 10121 UK Biobank participants (39% women) with MRI-confirmed liver steatosis. Latent class analysis was used to derive CMRF patterns based on 5 CMRFs (obesity, diabetes, hypertension, high triglycerides and low HDL). Cox models were used to estimate associations between CMRF count and patterns with incidence and mortality of cardiovascular disease (CVD), and all-cause mortality.
Results: Approximately 95% of SLD participants had ≥ 2 CMRFs. During a median follow-up of 4.9 years, 268 CVD events and 212 deaths were recorded. Higher CMRF count was independently associated with elevated risk of CVD (HR per each additional CMRF: 1.23 (1.08, 1.40)), CVD mortality (1.47 (1.07, 2.02)), and all-cause mortality (1.25 (1.08, 1.44)). Three distinct CMRF patterns were identified, reflecting varying levels of CMRF burden and demographic characteristics. While certain patterns with high CMRF burden were associated with increased CVD risk, the associations were substantially attenuated after adjusting for CMRF count.
Conclusions: CMRF burden is a key determinant of cardiovascular risk in people with SLD, but data-driven CMRF patterns do not improve risk prediction beyond simple counts. CMRF count remains a practical measure of cardiometabolic burden.
Methods: We included 10121 UK Biobank participants (39% women) with MRI-confirmed liver steatosis. Latent class analysis was used to derive CMRF patterns based on 5 CMRFs (obesity, diabetes, hypertension, high triglycerides and low HDL). Cox models were used to estimate associations between CMRF count and patterns with incidence and mortality of cardiovascular disease (CVD), and all-cause mortality.
Results: Approximately 95% of SLD participants had ≥ 2 CMRFs. During a median follow-up of 4.9 years, 268 CVD events and 212 deaths were recorded. Higher CMRF count was independently associated with elevated risk of CVD (HR per each additional CMRF: 1.23 (1.08, 1.40)), CVD mortality (1.47 (1.07, 2.02)), and all-cause mortality (1.25 (1.08, 1.44)). Three distinct CMRF patterns were identified, reflecting varying levels of CMRF burden and demographic characteristics. While certain patterns with high CMRF burden were associated with increased CVD risk, the associations were substantially attenuated after adjusting for CMRF count.
Conclusions: CMRF burden is a key determinant of cardiovascular risk in people with SLD, but data-driven CMRF patterns do not improve risk prediction beyond simple counts. CMRF count remains a practical measure of cardiometabolic burden.
Date Issued
2026-02-20
Date Acceptance
2026-01-12
Citation
Cardiovascular Diabetology, 2026, 25 (1)
ISSN
1475-2840
Publisher
BMC
Journal / Book Title
Cardiovascular Diabetology
Volume
25
Issue
1
Copyright Statement
© The Author(s) 2026. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit h t t p : / / c r e a t i v e c o m m o n s . o r g / l i c e n s e s / b y / 4 . 0 /
License URL
Identifier
10.1186/s12933-026-03088-1
Publication Status
Published
Article Number
64
Date Publish Online
2026-01-29