Metabolic Dysfunction-Associated Steatotic Liver Disease in Patients with Type 2 Diabetes: Risk of Heart Failure

Abstract BACKGROUND & AIMS The association between metabolic dysfunction-associated steatotic liver disease (MASLD) and cardiovascular outcomes in patients with type 2 diabetes mellitus (T2DM) is unclear. This study aimed to investigate the impact of MASLD on the risk of heart failure and cardiovascular (CV) mortality in patients with T2DM. METHODS In a nationwide cohort study, 2,745,689 adults with T2DM were followed from 2009–2012 until 2018. Participants were categorized into no steatotic liver disease (no SLD) and SLD groups. The SLD group was stratified based on metabolic risk factors, alcohol consumption, and other liver diseases. Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for heart failure (HF) and cardiovascular mortality risk. RESULTS The prevalence of MASLD, metabolic alcohol-associated liver disease (MetALD), MASLD with other co-existing liver diseases (Other), and alcohol-associated liver disease with metabolic dysfunction (ALD with MD) was 48.3%, 7.1%, 4.6%, and 2.2%. Individuals with MASLD (adjusted HR [aHR], 1.11), MetALD (aHR, 1.14), ALD with MD (aHR, 1.32) and Other (aHR, 1.23) had a higher risk of developing HF compared with the no SLD group. The risk of CV mortality was increased in those with MASLD, MetALD, ALD with MD and Other compared to those with no SLD. The risk of new-onset HF and cardiovascular mortality showed a J-shaped association with alcohol consumption regardless of SLD status. CONCLUSION SLD is independent risk factor of new-onset heart failure and cardiovascular mortality in persons with T2DM, and alcohol consumption has a J-shaped association with risk of HF and CV mortality, regardless of SLD status.