Measures of comorbid cardiometabolic burden and cardiovascular disease risk in people with MRI-confirmed steatotic liver disease: a prospective cohort study

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. We included 10,121 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. 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. 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.