Metabolic dysfunction-associated fatty liver disease (MAFLD) is a condition characterized by liver fat accumulation and metabolic abnormalities. Given the potential impact of MAFLD on patient health, it is important to understand its association with major adverse cardiovascular events (MACE) such as myocardial infarction (MI) and stroke. In the prospective UK Biobank cohort, we sought to elucidate the association of MAFLD and its subtypes with incident MI and stroke. In this study, we analyzed the data of 325,129 participants in the UK Biobank and calculated relative risks for MI and stroke using Cox regression analysis. Among 325,129 participants over a median duration of 12.8 years follow-up, participants with MAFLD were significantly more likely to experience a MI (hazard ratio [HR] = 1.35, 95% confidence interval [CI: 1.29;1.41] P < 0.001) or a stroke (HR = 1.26 [1.18–1.33] P < 0.001) compared to those without MAFLD. In addition, diabetic, overweight with metabolic dysfunction (MD), and lean MAFLD subtypes were significantly associated with an increased risk for MI and stroke, whereas overweight without MD subtype did not appear to be associated with this risk. Our findings also revealed graded associations between liver fibrosis scores and risk of MI and stroke in MAFLD patients. However, only diabetic, and overweight patients with MD subtypes exhibited graded associations between liver fibrosis score and the risk of MI and stroke among the MAFLD subtypes. Furthermore, the risk alleles traits of fatty liver did not enhance the effect of MAFLD on the risk of MI and stroke. In conclusion, a diagnosis of MAFLD is associated with an increased risk of MI or stroke, and the assessment of MAFLD and its subtypes should be a component of the cardiovascular risk assessment.

代谢功能障碍相关脂肪肝病（MAFLD）是一种以肝脏脂肪堆积和代谢异常为特征的疾病。鉴于 MAFLD 对患者健康的潜在影响，了解其与心肌梗死 (MI) 和中风等主要不良心血管事件 (MACE) 的关联非常重要。在英国生物银行前瞻性队列中，我们试图阐明 MAFLD 及其亚型与 MI 和中风事件的关联。在这项研究中，我们分析了英国生物银行 325,129 名参与者的数据，并使用 Cox 回归分析计算了 MI 和中风的相对风险。在中位随访时间为 12.8 年的 325,129 名参与者中，患有 MAFLD 的参与者明显更有可能经历 MI（风险比 [HR] = 1.35，95% 置信区间 [CI: 1.29;1.41] P < 0.001 ）或与无 MAFLD 的患者相比，中风发生率（HR = 1.26 [1.18–1.33] P < 0.001）。此外，糖尿病、超重伴代谢功能障碍 (MD) 和瘦 MAFLD 亚型与 MI 和中风风险增加显着相关，而无 MD 亚型的超重似乎与此风险无关。我们的研究结果还揭示了 MAFLD 患者的肝纤维化评分与 MI 和中风风险之间的分级关联。然而，只有患有 MD 亚型的糖尿病和超重患者在 MAFLD 亚型中表现出肝纤维化评分与 MI 和中风风险之间的分级关联。此外，脂肪肝的风险等位基因特征并没有增强 MAFLD 对 MI 和中风风险的影响。总之，MAFLD 的诊断与 MI 或中风的风险增加相关，MAFLD 及其亚型的评估应成为心血管风险评估的一部分。