Dear Editor
We read with great interest the recent article by [Gui Z et al.] on ‘Inflammatory and metabolic mediators of the association between liver steatosis and fibrosis with 10-year ASCVD risk’ published in Annals of Medicine [1]. This important study highlights the independent associations of hepatic steatosis and fibrosis with 10-year ASCVD risk and identifies insulin resistance, systemic inflammation, and atherogenic lipoproteins as partial mediators.
From a family medicine perspective, the findings are highly relevant. Metabolic dysfunction-associated steatotic liver disease (MASLD) is the most common chronic liver disorder globally, with a prevalence of approximately 25% [2]. In primary care, MASLD is frequently encountered as an incidental finding during routine health checks. The demonstration that controlled attenuation parameter (CAP) ≥301 dB/m marks a sharp rise in ASCVD risk provides a potential threshold for family physicians to intensify cardiovascular risk stratification.
The mediation effects of HOMA-IR (27%) and hs-CRP (15%) are particularly notable, as these markers reflect processes—insulin resistance, obesity, type 2 diabetes, and low-grade inflammation—routinely managed in primary care [3]. Current European Society of Cardiology guidelines already encourage a holistic assessment of cardiometabolic risk, including non-HDL cholesterol and remnant cholesterol [4]. Integrating such markers with FibroScan results could enhance preventive strategies in the primary care setting.
However, some limitations must be considered. The cross-sectional design prevents causal inference, and the findings may not be generalizable beyond the study population. Transient elastography results are also influenced by probe type and body habitus [5]. Further longitudinal, multiethnic studies are warranted to confirm whether these mediators independently predict ASCVD outcomes.
In conclusion, the study underscores the necessity of incorporating hepatic steatosis into cardiovascular prevention frameworks in primary care. Family physicians are uniquely positioned to implement early, comprehensive interventions addressing insulin resistance, systemic inflammation, and dyslipidemia in patients with MASLD, thereby potentially reducing long-term ASCVD burden.
Sincerely
Erhan Şimşek, MD, Assistant Professor
Ebru Uğraş, MD, Assistant Professor
Funding Statement
The author(s) reported there is no funding associated with the work featured in this article.
Disclosure statement
No potential conflict of interest was reported by the author(s).
Data availability statement
Data availability is not applicable to this article as no new data were created or analyzed in this study.
References
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Associated Data
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Data Availability Statement
Data availability is not applicable to this article as no new data were created or analyzed in this study.