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The following is a summary of “Objective measures of cardiometabolic risk and advanced fibrosis risk progression in primary care patients with metabolic dysfunction-associated steatotic liver disease,” published in the August 2024 issue of Endocrinology by Schreiner et al.

This study investigates the association between objective cardiometabolic risk factors and the progression to a high-risk state for advanced fibrosis in patients with Metabolic Associated Steatotic Liver Disease (MASLD), initially classified as low- or indeterminate risk for advanced fibrosis. Researchers conducted a retrospective cohort study encompassing patients in primary care diagnosed with MASLD between 2012 and 2021. The study focused on those with low- or indeterminate-risk scores on the Fibrosis-4 Index (FIB-4) and tracked their progression to a high-risk FIB-4 score (greater than 2.67) or until the end of the study period. The primary cardiometabolic risk factors analyzed included body mass index (BMI), systolic blood pressure (SBP), hemoglobin A1c, cholesterol levels, estimated glomerular filtration rate (eGFR), and smoking status, with variables categorized according to thresholds for intensifying primary care interventions. 

To assess the time to reach a high-risk FIB-4 score, investigators developed both unadjusted and adjusted Cox regression models. The study cohort consisted of 1,347 patients, with an average follow-up period of 3.6 years (standard deviation of 2.7 years). About 258 patients (19%) progressed to a high-risk FIB-4 score during this time. In fully adjusted Cox regression models, a mean SBP greater than 150 mm Hg (hazard ratio [HR] 1.57; 95% CI 1.02-2.41) and an eGFR below 59 ml/min (HR 2.78; 95% CI 2.17-3.58) were significantly associated with an increased hazard of developing a high-risk FIB-4 score. Conversely, using statins was associated with a reduced risk of progression (HR 0.51; 95% CI 0.39-0.66). These findings highlight that nearly 1 in 5 patients with MASLD in primary care advanced to a high-risk FIB-4 score over a follow-up period of 3.6 years. 

The study underscores the importance of managing uncontrolled blood pressure and maintaining kidney function as key factors in preventing the progression to advanced fibrosis in this patient population. Additionally, the protective effect of statin use suggests potential therapeutic avenues for reducing the risk of fibrosis progression in patients with MASLD, offering hope for improved patient outcomes.

Source: sciencedirect.com/science/article/abs/pii/S1530891X24006487