Prevalence and clinical correlates of metabolic dysfunction-associated steatotic liver disease in heart failure.
20 affiliations
- 1Department of Cardiology, National University Heart Centre, National University Hospital, Singapore.
- 2Duke-NUS Medical School, Singapore.
- 3National Heart Centre, Singapore.
- 4University of Amsterdam, Amsterdam, The Netherlands.
- 5Department of Medicine, Queen Mary Hospital, Hong Kong, Hong Kong.
- 6Institute of Cardiovascular Sciences and Medicine, Hong Kong, Hong Kong.
- 7Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
- 8Saw Swee Hock School of Public Health, National University of Singapore, Singapore.
- 9Department of Cardiovascular Medicine, University of Minnesota, Minneapolis, Minnesota, USA.
- 10Heart Failure Program, VA Medical Center, Minneapolis, Minnesota, USA.
- 11Christchurch Heart Institute, University of Otago, Dunedin, Otago, New Zealand.
- 12Cardiovascular Research Institute, National University Heart Centre, Singapore.
- 13Division of Gastroenterology and Hepatology, Department of Medicine, National University Hospital, Singapore.
- 14National University Centre for Organ Transplantation, National University Health System, Singapore.
- 15Université de Lorraine and CHRU, Nancy, France.
- 16Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
- 17School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK.
- 18Division of Cardiology, Department of Medicine, University of Hong Kong-Shenzhen Hospital, Shenzhen, Guangdong, China.
- 19University of Groningen, Groningen, The Netherlands.
- 20Duke-NUS Medical School, Singapore [email protected].
Abstract
Background The nomenclature change from non-alcoholic fatty liver disease to metabolic dysfunction-associated steatotic liver disease (MASLD) better encapsulates the associated metabolic milieu. While MASLD is associated with increased heart failure (HF) risk, characteristics and outcomes of MASLD in patients with HF remain unclear. This paper aims to examine the prevalence and clinical correlates of MASLD in patients with HF from the Asian Sudden Cardiac Death in Heart Failure (ASIAN-HF) Registry. Methods MASLD was defined as evidence of hepatic steatosis, with at least one of five metabolic criteria (among body mass index, glucose, blood pressure, triglycerides and high-density lipoprotein thresholds). Findings were externally validated in Clinical Data Analysis and Reporting System (CDARS), a Hong Kong HF cohort and BIOlogy Study to TAilored Treatment in Chronic Heart Failure (BIOSTAT-CHF), a HF cohort across 11 European countries. Results Of 2698 patients with HF in ASIAN-HF, 927 (34.4%) had MASLD. They were younger, more often women and more likely to have HF with preserved ejection fraction (HFpEF) compared with those without MASLD. All-cause mortality was lower in MASLD versus non-MASLD (7.1% vs 11.7%, p=0.001), even after multivariable adjustment (adjusted HR (aHR) 0.58, 95% CI 0.39 to 0.86, p=0.007). Allcause mortality was also lower in MASLD versus non-MASLD in CDARS and BIOSTAT-CHF; however, after multivariable adjustment, the association remained significant only in CDARS (aHR 0.82, 95% CI 0.80 to 0.84, p<0.001) and was attenuated in BIOSTAT-CHF (aHR 1.08, 95% CI 0.67 to 1.73, p=0.750). Using waist-to-height ratio instead of body mass index in the MASLD definition reclassified <3% of patients. Conclusions In patients with HF, MASLD is highly prevalent, especially in younger women with HFpEF and is associated with better 1-year survival than in those without MASLD.
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BibTeX
@article{chew2026prevalence,
title = {{Prevalence and clinical correlates of metabolic dysfunction-associated steatotic liver disease in heart failure.}},
author = {Nicholas Ws Chew and Chandramouli Chanchal and Wan Ting Tay and Wouter Ouwerkerk and Qingwen Ren and Tiew-Hwa Katherine Teng and Yiming Chen and Bryan Chong and Haryo Teguh Raden Himan and Jasper Tromp and Inder S Anand and Arthur Mark Richards and Mark Dhinesh Muthiah and Faiez Zannad and Muthiah Vaduganathan and Naveed Sattar and Kai Hang Yiu and Adriaan A Voors and Carolyn S P Lam and ASIAN-HF Investigators},
journal = {Open heart},
year = {2026},
month = oct,
doi = {10.1136/openhrt-2026-004357},
url = {https://europepmc.org/article/MED/42906951},
note = {CC BY-NC},
}
RIS
TY - JOUR
TI - Prevalence and clinical correlates of metabolic dysfunction-associated steatotic liver disease in heart failure.
AU - Nicholas Ws Chew
AU - Chandramouli Chanchal
AU - Wan Ting Tay
AU - Wouter Ouwerkerk
AU - Qingwen Ren
AU - Tiew-Hwa Katherine Teng
AU - Yiming Chen
AU - Bryan Chong
AU - Haryo Teguh Raden Himan
AU - Jasper Tromp
AU - Inder S Anand
AU - Arthur Mark Richards
AU - Mark Dhinesh Muthiah
AU - Faiez Zannad
AU - Muthiah Vaduganathan
AU - Naveed Sattar
AU - Kai Hang Yiu
AU - Adriaan A Voors
AU - Carolyn S P Lam
AU - ASIAN-HF Investigators
PY - 2026
DA - 2026/10/21
JO - Open heart
DO - 10.1136/openhrt-2026-004357
UR - https://europepmc.org/article/MED/42906951
AB - Background The nomenclature change from non-alcoholic fatty liver disease to metabolic dysfunction-associated steatotic liver disease (MASLD) better encapsulates the associated metabolic milieu. While MASLD is associated with increased heart failure (HF) risk, characteristics and outcomes of MASLD in patients with HF remain unclear. This paper aims to examine the prevalence and clinical correlates of MASLD in patients with HF from the Asian Sudden Cardiac Death in Heart Failure (ASIAN-HF) Registry. Methods MASLD was defined as evidence of hepatic steatosis, with at least one of five metabolic criteria (among body mass index, glucose, blood pressure, triglycerides and high-density lipoprotein thresholds). Findings were externally validated in Clinical Data Analysis and Reporting System (CDARS), a Hong Kong HF cohort and BIOlogy Study to TAilored Treatment in Chronic Heart Failure (BIOSTAT-CHF), a HF cohort across 11 European countries. Results Of 2698 patients with HF in ASIAN-HF, 927 (34.4%) had MASLD. They were younger, more often women and more likely to have HF with preserved ejection fraction (HFpEF) compared with those without MASLD. All-cause mortality was lower in MASLD versus non-MASLD (7.1% vs 11.7%, p=0.001), even after multivariable adjustment (adjusted HR (aHR) 0.58, 95% CI 0.39 to 0.86, p=0.007). Allcause mortality was also lower in MASLD versus non-MASLD in CDARS and BIOSTAT-CHF; however, after multivariable adjustment, the association remained significant only in CDARS (aHR 0.82, 95% CI 0.80 to 0.84, p<0.001) and was attenuated in BIOSTAT-CHF (aHR 1.08, 95% CI 0.67 to 1.73, p=0.750). Using waist-to-height ratio instead of body mass index in the MASLD definition reclassified <3% of patients. Conclusions In patients with HF, MASLD is highly prevalent, especially in younger women with HFpEF and is associated with better 1-year survival than in those without MASLD.
SN - 2053-3624
ER -