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. 2025 May 29;24(1):230.
doi: 10.1186/s12933-025-02764-y.

Increased prevalence and risk of atherosclerotic cardiovascular disease in individuals with Type 1 diabetes and metabolic dysfunction-associated steatotic liver disease

Jonathan Mertens  1   2   3 , Jonas Weyler  2   3 , Eveline Dirinck  1   2 , Luisa Vonghia  2   3 , Wilhelmus J Kwanten  2   3 , Luc F Van Gaal  1 , Benedicte Y De Winter  2 , Sven Francque #  2   3 , Christophe De Block #  4   5
Affiliations

Increased prevalence and risk of atherosclerotic cardiovascular disease in individuals with Type 1 diabetes and metabolic dysfunction-associated steatotic liver disease

Jonathan Mertens et al. Cardiovasc Diabetol. .

Abstract

Objective: This study aimed to investigate the correlation between metabolic dysfunction-associated steatotic liver disease (MASLD) and atherosclerotic cardiovascular disease (ASCVD) in individuals with type 1 diabetes (T1D).

Methods: Adults with T1D (n = 659) were consecutively screened for liver steatosis via abdominal ultrasound. The presence of macrovascular disease (including coronary artery disease [CAD], peripheral artery disease [PAD], or ischaemic stroke [CVA, cerebrovascular accident]) was identified via electronic medical records. The 5- and 10-year risks of fatal/nonfatal ASCVD were assessed via the Steno Type 1 Risk Engine. Insulin resistance was assessed via the estimated glucose disposal rate (eGDR).

Results: The MASLD prevalence was 16.8%. The prevalence of composite ASCVD (18.9 vs. 6.8%, p < 0.001), CAD (9.9 vs. 4.7%, p = 0.031), PAD (9.0 vs. 2.2%, p < 0.001) and CVA (6.3 vs. 1.1%, p = 0.002) was greater in people with MASLD. The 5-year (7.8 [2.1-14.4] vs. 4.8 [1.6-12.0]%, p = 0.034) and 10-year (15.0 [4.1-26.8] vs. 9.4 [3.1-22.5]%, p = 0.035) risks of ASCVD were greater in those with MASLD. MASLD was associated with prevalent ASCVD (adjusted OR 4.26, 95% CI 1.79-10.11, p < 0.001), independent of age, sex, diabetes duration, smoking, statin use, LDL-cholesterol, the glomerular filtration rate, albuminuria, and metabolic syndrome.

Conclusion: MASLD is associated with both an increased prevalence of ASCVD and an increased calculated risk of fatal/nonfatal ASCVD in people with T1D.

Keywords: Atherosclerotic cardiovascular disease; Insulin resistance; MASLD; Metabolic syndrome; Type 1 diabetes.

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Conflict of interest statement

Declarations. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Study flowchart and distribution of steatotic liver disease subtypes across the cohort. T1D: type 1 diabetes, VCTE: vibration-controlled transient elastography, MASLD: metabolic dysfunction-associated steatotic liver disease, NAFLD: non-alcoholic fatty liver disease, metALD: MASLD with moderate alcohol consumption
Fig. 2
Fig. 2
Distribution of micro- and macrovascular events in people with/without MASLD. The figure shows the distribution of microvascular (microalbuminuria and retinopathy) and macrovascular events. P values are shown numerically above each bar graph. P values were derived from the chi-square test or Fisher’s exact test when appropriate. MASLD: metabolic dysfunction-associated steatotic liver disease, CKD: chronic kidney disease defined as eGFR < 60 mL/min/1.73 m2 and/or albuminuria (albumin excretion rate > 30 mg/24 h) in the absence of other readily available diagnoses other than diabetes, CAD: coronary artery disease, PAD: peripheral arterial disease, CVA: cerebrovascular disease, ASCV: cardiovascular disease
Fig. 3
Fig. 3
Subgroup analysis of the Steno Type 1 Risk Engine derived 5- and 10-year risk factors for ASCVD. The figure shows a bar plot of the Steno Type 1 Risk Engine derived 5- and 10-year risks of atherosclerotic cardiovascular disease (ASCVD). P values of post hoc comparisons (LSD) are shown above the bar plots. The numbers above the bar plots represent individual risk percentages per subgroup. M+MetS+: MASLD and metabolic syndrome, M+MetS-: MASLD without metabolic syndrome, M-MetS+: metabolic syndrome without MASLD, M-MetS-: no MASLD, no metabolic syndrome
See this image and copyright information in PMC

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