Metabolic Dysfunction Associated Steatotic Liver Disease Is a Systemic Vascular Disorder Characterized by Increased Arterial Stiffness

Objective: Metabolic dysfunction associated steatotic liver disease (MASLD)is increasingly recognized as a systemic cardiometabolic disorder; however, its association with arterial stiffness independent of blood pressure and metabolic confounders remains incompletely defined. We investigated whether MASLD is independently associated with increased arterial stiffness assessed by the cardio ankle vascular index.Design and method: In a retrospective observational cohort, arterial stiffness was evaluated using the cardio ankle vascular index. MASLD was defined according to contemporary consensus criteria based on hepatic steatosis and cardiometabolic abnormalities. Linear regression analysis was performed with cardio ankle vascular index as a continuous outcome. Logistic regression analyses were conducted using severe arterial stiffness defined as cardio ankle vascular index >9.0. All models were adjusted for age, sex, body mass index, waist circumference, smoking status, hypertension, diabetes, dyslipidemia, medication use, and estimated glomerular filtration rate. Additional analyses were stratified by hypertension status. Results: Among the study population, individuals with MASLD exhibited significantly higher cardio ankle vascular index values compared with those without the disease. In multivariable linear regression analysis, MASLD was independently associated with higher arterial stiffness, with an adjusted beta coefficient of +0.85 (95% confidence interval 0.67 to 1.03, p9.0 (adjusted odds ratio 5.58, 95% confidence interval 3.73 to 8.34, p<0.001). In hypertension stratified analyses, the association remained significant both in individuals with hypertension (odds ratio 10.96, 95% confidence interval 6.43 to 18.66) and in those without hypertension (odds ratio 3.23, 95% confidence interval 1.44 to 7.28). Conclusions: MASLD is independently associated with increased arterial stiffness assessed by the cardio ankle vascular index, irrespective of blood pressure status and metabolic risk factors. These findings highlight MASLD as a systemic vascular disorder and support the use of arterial stiffness assessment for early vascular risk stratification in this population.