Do biomarkers matter? Cardiovascular risk stratification in Asian patients with metabolic dysfunction-associated steatotic liver disease in the era of fibrosis-centric assessment

Table 1 Selected Asian cohort studies linking metabolic dysfunction-associated steatotic liver disease or metabolic dysfunction-associated steatotic liver disease to cardiovascular outcomes

Ref.	Study population	Sample size	Outcome	Key finding	Effect size
[21]	Korea	9584399	Composite CVD event	MASLD identified a larger, more cardiometabolically complex population than MASLD	HR 1.43 for MASLD-only; HR 1.56 for both-FLD vs neither
[22]	Korea	351068	Incident MI or stroke	MASLD independently increased CVD risk	SHR 1.19 vs no SLD
[23]	Korea	104399	Incident CVD	Excess risk in MASLD concentrated in FIB-4-defined fibrosis	HR 2.27 for MASLD with FIB-4 ≥ 1.3
[24]	Taiwan	26676	Incident HF	MASLD associated with HF, especially HFpEF	SHR 2.59 for HF; SHR 1.91 for HFpEF
[25]	Korea	2773	Coronary artery calcification	Both labels associated with CAC, but MASLD tracked severe CAC more consistently	aOR 1.21 for CAC and 1.38 for severe CAC
[26]	China	203	Obstructive CAD and high-risk plaque	MASLD predicted adverse plaque anatomy and physiology	aOR 2.44 for obstructive CAD; 2.52 for HRP; 3.53 for FFRCT ≤ 0.8
[27]	Taiwan	6058	Coronary artery calcification	FIB-4 provided incremental referral value within MASLD	OR 1.217 per FIB-4 unit for CAC presence
[28]	Korea	8622	Any plaque and obstructive CAD	SAFE score and MASLD both stratified subclinical coronary atherosclerosis	MASLD OR 3.64 for obstructive CAD; higher SAFE strongly associated with plaque and obstruction

CVD: Cardiovascular disease; MASLD: Metabolic dysfunction-associated steatotic liver disease; HR: Hazard ratio; FLD: Fatty liver disease; MI: Myocardial infarction; SHR: Subdistribution hazard ratio; SLD: Steatotic liver disease; FIB-4: Fibrosis-4 index 4; HF: Heart failure; HFpEF: Heart failure with preserved ejection fraction; CAC: Coronary artery calcium; aOR: Adjusted odds ratio; CAD: Coronary artery disease; HRP: Hazard ratio point; FFRCT: Fractional flow reserve derived from computed tomography; OR: Odds ratio; SAFE: Steatosis-activity-fibrosis evaluation index.