S2557 Sex Disparities, Trends, and Factors Associated With Cardiovascular Outcomes in Metabolic Associated Steatotic Liver Disease

Introduction: Major adverse cardiovascular events (MACEs) are contributors to morbidity in patients with liver disease. Limited data exist on cardiovascular outcomes among patients with MASLD. We analyzed the national trends, predictors, and sex disparities in the incidence of MACEs among patients with MASLD in the United States from 2016 to 2021. Methods: We retrospectively analyzed the 2016-2021 National Inpatient Sample database. Hospitalizations for MASLD were identified using International Classification of Diseases, Tenth Revision (ICD-10) codes, and outcomes, including MACEs, inpatient mortality, and comorbidities, were assessed. Multivariate regression was used to determine the predictors of MACEs. Trends in MACE incidence were analyzed using weighted national estimates and Cuzick’s trend tests. Results: A total of 31,975 hospitalizations for MASLD were analyzed, comprising 19,730 women (61.7%) and 12,246 men (38.3%). The incidence of MACEs was 8.9% (2,846), with a higher rate in men (1,185, 9.7%) than in women (1,660, 8.4%). Acute heart failure was the most frequent type of MACE (1,390; 4.3%). Predictors of MACEs included a higher baseline mortality risk (AOR: 3.41, P < 0.001), congestive heart failure (AOR: 4.81, P < 0.001), and previous ischemic stroke (AOR: 4.47, P < 0.001). From 2016 to 2021, the incidence of acute heart failure increased significantly (1,023 [3.2%] to 1,918 [6.0%], Ptrend < 0.001), while that of acute myocardial infarction decreased from 416 (1.3%) to 96 (0.3%) (Ptrend = 0.027). No significant trends were observed in acute ischemic stroke or in-hospital mortality. A total of 31,975 hospitalizations for MASLD were analyzed, comprising 19,730 women (61.7%) and 12,246 men (38.3%). The incidence of MACEs was 8.9% (2,846), with a higher rate in men (1,185, 9.7%) than in women (1,660, 8.4%). Acute heart failure was the most frequent type of MACE (1,390; 4.3%). Predictors of MACEs included a higher baseline mortality risk (AOR: 3.41, P < 0.001), congestive heart failure (AOR: 4.81, P < 0.001), and previous ischemic stroke (AOR: 4.47, P < 0.001). From 2016 to 2021, the incidence of acute heart failure increased significantly (1,023 [3.2%] to 1,918 [6.0%], Ptrend < 0.001), while that of acute myocardial infarction decreased from 416 (1.3%) to 96 (0.3%) (Ptrend = 0.027). Conclusion: Nearly 1 in 10 individuals with MASLD experienced a MACE with acute heart failure being most common and showing a significant uptrend over the study period. Previous ischemic stroke and coexisting congestive heart failure are important predictors of MACE.