Comparative Analysis of Atherogenic Dyslipidemia Patterns in Alcoholic Versus Metabolic Dysfunction-Associated Steatotic Liver Disease: Implications for Cardiovascular Risk Stratification

Background: Abnormal lipid metabolism is a hallmark of both alcohol-related fatty liver disease (AFLD) and metabolic dysfunction-associated steatotic liver disease (MASLD), both of which heighten cardiovascular risk. However, comparative data on lipid abnormalities between these two conditions remain sparse, especially among South Asian populations. Objective: To systematically compare atherogenic lipid profiles between patients with AFLD and MASLD. Methods: This cross-sectional study enrolled 90 participants, including 30 with AFLD, 30 with MASLD, and 30 healthy controls. Fasting serum samples were assessed for total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), triglycerides (TG), and non-HDL-C. Additionally, atherogenic indices and lipid ratios were calculated. Group differences were analyzed using ANOVA with post-hoc tests and multivariable regression (α = 0.05). Results: Both disease groups showed significant dyslipidemia relative to controls (p < 0.001). MASLD patients exhibited the most unfavorable profile (TC = 220 ± 25 mg/dL, LDL-C = 150 ± 20 mg/dL, TG = 200 ± 50 mg/dL) compared to AFLD (TC = 200 ± 30, LDL-C = 130 ± 25, TG = 180 ± 60 mg/dL) and controls (TC = 180 ± 20, LDL-C = 110 ± 15, TG = 120 ± 40 mg/dL). HDL-C was lowest in AFLD (40 ± 10 mg/dL), intermediate in MASLD (45 ± 8 mg/dL), and highest in controls (55 ± 12 mg/dL). The atherogenic index (log[TG/HDL-C]) was significantly higher in MASLD (0.65 ± 0.18) than in AFLD (0.55 ± 0.21) and controls (0.35 ± 0.15; p < 0.001). Conclusion: MASLD is associated with a more severe atherogenic lipid pattern marked by elevated TC, LDL-C, and TG, whereas AFLD features a more pronounced reduction in HDL-C. These distinct profiles suggest differing cardiovascular risk trajectories and support etiology-specific lipid management approaches.