The burden and mortality impact of cardiovascular disease-metabolic dysfunction-associated steatotic liver disease comorbidity

Abstract

Background: Cardiovascular disease (CVD) and metabolic dysfunction-associated steatotic liver disease (MASLD) are metabolically linked, yet their combined burden and mortality impact remain underexplored.

Methods: Using Global Burden of Disease (GBD) 2023 data, we assessed temporal and regional trends in CVD, MASLD, and metabolic risk factors. National Health and Nutrition Examination Survey (NHANES) data were subsequently analyzed to examine the association between CVD-MASLD comorbidity and mortality using multivariable and survival models.

Results: From 1990 to 2023, the global burden of CVD declined steadily, whereas MASLD rose continuously, showing divergent and regionally heterogeneous trends. In high-income countries, CVD indicators decreased despite increasing MASLD burden, whereas this inverse pattern was weaker in upper-middle-income regions. In NHANES, individuals with CVD-MASLD comorbidity exhibited the highest metabolic abnormalities and mortality risk. Compared with those without comorbidities, adjusted hazard ratios were 1.68 for all-cause and 2.68 for cardiovascular mortality. Mortality rose progressively with fibrosis severity. PAF analyses showed that CVD, MASLD, and their comorbidity accounted for 13.3%, 1.3%, and 7.8% of cardiovascular deaths, respectively, totaling 22.4%. These associations demonstrated marked age-related heterogeneity.

Conclusion: CVD-MASLD comorbidity is an emerging global concern associated with excess mortality, emphasizing the need to incorporate MASLD screening and fibrosis evaluation into cardiovascular prevention strategies.

Keywords: Cardiovascular disease; Metabolic dysfunction–associatedsteatotic liver disease; Mortality; The burden of comorbidity.