Glycemic Status Alters Link Between Liver Fibrosis and ASCVD in MASLD Patients

Patients with metabolic dysfunction‑associated steatotic liver disease (MASLD) may face a variable risk of atherosclerotic cardiovascular disease (ASCVD) that depends on their glycemic status, a new study in *Hepatology Communications* reports. The research examined a cohort of MASLD patients and found that the strength of the association between liver fibrosis and ASCVD differs markedly between those with normal glucose tolerance and those with impaired glucose regulation or diabetes. In individuals with higher blood glucose levels, the link between advanced fibrosis and cardiovascular events was more pronounced, suggesting that hyperglycemia may amplify cardiovascular risk in this population.

The investigators measured fibrosis stage using non‑invasive imaging and correlated these findings with ASCVD outcomes over a median follow‑up of several years. While fibrosis alone has long been recognized as a marker for liver‑related complications, the study highlights that glycemic control could be a pivotal modifier of cardiovascular risk in MASLD patients. These results underscore the importance of integrated metabolic management, where monitoring and treating dysglycemia may help mitigate the heightened ASCVD risk associated with progressive liver fibrosis.

Clinicians treating MASLD should consider routine cardiovascular risk assessment, particularly in patients with impaired glucose tolerance or diabetes. The study’s findings support a more nuanced approach to risk stratification, where both liver fibrosis stage and glycemic status inform preventive strategies. Further research is needed to determine whether targeted glucose‑lowering interventions can reduce ASCVD incidence in this high‑risk group.