Cardiometabolic comorbidity and health outcomes of persons with metabolic dysfunction–associated steatotic liver disease (MASLD) in Ontario, Canada

Background: We aimed to describe the prevalence of cardiometabolic disease and clinical outcomes of persons with metabolic dysfunction–associated steatotic liver disease (PwMASLD). Methods: PwMASLD in Ontario, Canada, were identified using administrative data sets between January 1, 2013, and December 31, 2021, and followed until December 31, 2022. PwMASLD were categorized into three mutually exclusive subgroups: (a) MASLD-only, without metabolic dysfunction–associated steatohepatitis (MASH) or cirrhosis, (b) MASH without cirrhosis, and (c) MASLD/MASH with cirrhosis. Cardiometabolic comorbidity, mortality, and cardiovascular- and liver-related outcomes were described for PwMASLD and matched controls (individuals from the general population without MASH/MASLD). Results: Data from 18,202 PwMASLD and 72,770 controls were analyzed. The mean age of PwMASLD was 53.4 years, 56% were female, and 88% resided in an urban area. Of these, 12,729 (70%), 2,675 (15%), and 2,798 (15%) were in the MASLD-only, MASH, and cirrhosis subgroups, respectively. Cardiovascular disease, type 2 diabetes, and hypertension were higher in PwMASLD versus controls. Liver- (29.2% versus 1.4%) and cardiovascular-related (16.8% versus 6.6%) health outcomes were also greater in PwMASLD. PwMASLD with cirrhosis had the highest burden of comorbidities, followed by MASH and MASLD-only subgroups. The cirrhosis subgroup had the highest rates of cardiovascular- and liver-related outcomes. Conclusions: PwMASLD in Ontario had more comorbidities and poorer health outcomes than controls. PwMASLD with cirrhosis showed the highest burden of disease versus those with MASH or MASLD alone. To ensure effective MASLD management, early identification of advanced disease and access to interventions to delay or prevent its progression must be improved.