Background:
Metabolic dysfunction-associated steatotic liver disease (MASLD) is increasingly recognized as a systemic condition with significant implications for cardiovascular health. While its connection to coronary artery disease (CAD) has been well-documented, the association between MASLD and systemic atherosclerosis remains underexplored. This study aimed to examine the relationship between non-invasive MASLD markers and the extent of atherosclerotic burden across multiple vascular regions.
Methods:
We performed a retrospective analysis involving 56 patients who underwent coronary angiography, vascular ultrasonography (carotid, lower limb, and abdominal aorta), and transient liver elastography (FibroScan®) between 2023 and 2025. Liver parameters included liver stiffness measurement (LSM), controlled attenuation parameter (CAP), and non-invasive scores: FibroScan-AST (FAST), Fibrosis-4 Index (FIB-4), and AGILE 3+. Atherosclerotic burden was categorized as disease-free, focal (1 site), intermediate (2–3 sites), or generalized (4–6 sites) based on six vascular territories, and was quantified using SYNTAX I, Gensini, NASCET, Bollinger, and Kronzon scores.
Results:
Liver stiffness and steatosis parameters were significantly associated with higher atherosclerotic burden. Patients with atherosclerotic cardiovascular disease (ASCVD, n = 45) had significantly higher liver stiffness (LSM: 5.8 [4.2–7.5] vs. 4.5 [3.0–5.1] kPa; p = 0.0472) and steatosis (CAP: 253 [220.5–290.5] vs. 210 [184–251.0] dB/m; p = 0.0097) compared to those without ASCVD. Non-invasive liver scores were significantly elevated in ASCVD patients and correlated with vascular burden after adjusting for age and sex: AGILE 3+ showed associations with SYNTAX I (β = 0.008446, p = 0.0045), Gensini (β = 0.0024, p = 0.049), and Kronzon score (β = 0.06413, p = 0.0274). FAST correlated with the Kronzon score (β = 0.04011, p = 0.0064). Hepatic steatosis (CAP ≥ 248 dB/m) or fibrosis (LSM ≥ 6.5 kPa) was present in 73.3% of ASCVD patients compared to 36.4% in the non-ASCVD group (p = 0.0325).
Conclusion:
Non-invasive liver markers, especially the AGILE 3+ score, were strongly associated with the presence and extent of systemic atherosclerosis. These findings support the concept of a "liver–vascular axis" and suggest that liver-derived markers may serve as valuable surrogates for assessing cardiovascular risk in patients with MASLD.
