MASLD in chronic hepatitis B was associated with higher cardiovascular and extrahepatic cancer risks over 13.7 years.
MASLD in Chronic Hepatitis B Signals Systemic Risk
MASLD in chronic hepatitis B was associated with higher cardiovascular and extrahepatic cancer risks over 13.7 years.
The population-based cohort study included 3,269 adults with chronic hepatitis B virus infection from northern China. Researchers examined whether concurrent metabolic dysfunction associated steatotic liver disease influenced the development of primary liver cancer, extrahepatic cancers, and cardiovascular disease.
At baseline, 26.5% of participants had MASLD. These individuals were more likely to be overweight and have hypertension, prediabetes, or Type 2 diabetes than participants without MASLD.
After adjustment for lifestyle, metabolic, inflammatory, and liver related variables, MASLD was associated with a 98% higher risk of cardiovascular disease and a 50% higher risk of extrahepatic cancers. Cardiovascular outcomes included myocardial infarction, ischemic stroke, and hemorrhagic stroke.
Cardiovascular Disease Risk Remained Elevated
The 12-year cumulative incidence of cardiovascular disease was 9.4% among participants with MASLD, compared with 4.9% among those without MASLD.
Elevated cardiovascular disease risk was observed even among participants with mild steatosis or normal alanine aminotransferase levels. This finding indicates that apparently limited liver involvement or normal liver enzyme results may not identify individuals with lower systemic risk.
Cardiovascular risk also remained elevated among participants whose MASLD had reversed by follow up. Compared with individuals who remained free from MASLD, those with reversed MASLD had approximately twice the risk of cardiovascular disease. Participants with persistent MASLD had a similarly elevated risk.
Extrahepatic Cancer Risk Increased with Persistent MASLD
Researchers recorded 36 extrahepatic cancers among participants with MASLD and 69 among those without the condition. Persistent MASLD was associated with a 98% higher risk of extrahepatic cancers compared with persistent non-MASLD.
However, MASLD was not independently associated with primary liver cancer after adjustment for lifestyle and metabolic variables. Instead, the joint analysis identified a synergistic interaction between chronic hepatitis B and cardiometabolic risk factors in primary liver cancer development.
The findings support continued metabolic management and cardiovascular monitoring for people with chronic hepatitis B, including those with normal alanine aminotransferase levels or resolved hepatic steatosis. The authors emphasized that virological control and metabolic health should both form part of long-term clinical assessment.
The study was limited by the absence of longitudinal hepatitis B virus DNA, antiviral treatment, and early fibrosis data. Hepatic steatosis was also assessed using ultrasonography, and the findings require validation in populations with different ethnic and lifestyle backgrounds.
Reference
Wang X et al. Concurrent MASLD and Long-term Outcomes in HBV-infected Individuals: A Population-based Cohort Study. Biomed Environ Sci. 2026;39(7):785-798.
Featured Image: littlewolf1989 on Adobe Stock.
