Prevalence of Liver Steatosis and Fibrosis Assessed by Transient Elastography in a High Cardiovascular-Risk Outpatient Cohort Including T1DM and T2DM Patients

Abstract

Background: Metabolic dysfunction-associated steatotic liver disease (MASLD) is common in T2DM, likely due to insulin resistance and obesity. Although screening is recommended in high-risk patients, its prevalence in outpatient cardiovascular clinical settings remains unclear. Methods: We analyzed data from 475 patients attending a cardiovascular outpatient clinic: 142 with T2DM, 78 with T1DM, and 255 non-diabetic individuals at elevated cardiovascular risk. Liver steatosis and fibrosis were assessed using vibration-controlled transient elastography (Fibroscan®): steatosis by controlled attenuation parameter (CAP ≥ 275 dB/m), and fibrosis risk by liver stiffness measurement (LSM ≥ 8.1 kPa). Carotid intima-media thickness (cIMT) was also measured. Results: The cohort (47% women, mean age 53 years, BMI 29.8 kg/m2) showed MASLD in 39.2% and fibrosis risk in 18.3%. MASLD was most prevalent in T2DM (57.0%), followed by non-diabetics (35.3%) and T1DM (19.2%) (p < 0.001). Fibrosis risk was also highest in T2DM (22.5%) vs. T1DM (7.7%) and non-diabetics (19.2%) (p = 0.02). CAP values were higher in those with fibrosis risk. T2DM patients with MASLD had higher LSM (7.0 ± 3.0 kPa) compared to those without MASLD (5.1 ± 2.2 kPa; p < 0.001). cIMT was highest in T2DM (0.73 ± 0.12 mm; p = 0.04), but not associated with MASLD or fibrosis. BMI and triglycerides were the strongest predictors of both MASLD and fibrosis. Conclusions: MASLD and risk of significant fibrosis were highest among T2DM patients. Within T2DM, those with MASLD had higher LSM, indicating increased risk of fibrosis. The presence of MASLD and risk of significant fibrosis was not associated with cIMT in this cardiometabolic cohort. BMI and plasma TG were consistent predictors across groups urging for more strict control by body weight reduction and lifestyle interventions.