The Study
Cardiovascular risk assessment tools are insufficient for patients with metabolic dysfunction associated steatotic liver disease.
This study looked at whether common heart risk calculators work well for people with a fatty liver condition. It found that these calculators often guess wrong—but it doesn’t prove the fatty liver causes the wrong guesses. It just shows they’re often inaccurate together.
Analysis score
Maximum 72 for a cohort study.
Where the score came from
Doctors use math tools to guess who will have a heart attack, but these tools don't work well for people with fatty liver disease.
Where does this study sit?
Reviews of RCTs (Meta-analyses)
Max 100Randomized Trials
Max 90Reviews of Cohort Studies
Max 85Cohort Studies
Max 72Reviews of Case-Control Studies
Max 63Case-Control Studies
Max 58Cross-Sectional & Case Series
Max 50Expert Opinion
Max 552 / 100
Quality score
Groups of people are followed over time to see who develops an outcome. Strong for identifying risk factors and associations, but cannot prove causation as firmly as RCTs.
Key takeaways
Summary
Based on the study abstract and findings.
- 1Yes — because heart disease is the #1 cause of death in these patients, using wrong tools means people might not get needed treatment or get unnecessary treatments.
- 2The tools got it right only slightly better than flipping a coin (C-statistic 0.58–0.60), and they wrongly said high-risk people were even higher risk, while low-risk people were at lower risk than they really were.
Score breakdown, methodology, conflicts of interest, evidence analysis & raw study data
Publication
Journal
The American journal of gastroenterology
Year
2025
Authors
A. Barritt, Elliot B. Tapper, Phillip N. Newsome, Derek Gazis, Heather Morris, Andrea R. Mospan, A. Perez, Yestle Kim, Brent A. Neuschwander-Tetri, R. Loomba, Arun Sanyal
Related Content
Claims (6)
Doctors should evaluate overall metabolic health when assessing cardiovascular disease risk, rather than focusing only on single blood test results.
In people with metabolic dysfunction-associated steatotic liver disease, two commonly used heart disease risk calculators consistently give wrong predictions: they overstate risk for those predicted to be at highest risk and understate risk for those predicted to be at lowest risk, making them unreliable for clinical decisions.
The PREVENT equation cannot reliably identify which adults with metabolic dysfunction-associated steatotic liver disease will have a cardiovascular event, as its accuracy is no better than flipping a coin.
In people with metabolic dysfunction-associated steatotic liver disease, two commonly used heart disease risk calculators—Framingham Risk Score and Pooled Cohort Equation—do not accurately identify who will have a cardiovascular event. They overestimate risk in high-risk groups and underestimate risk in low-risk groups.
In adults with metabolic dysfunction-associated steatotic liver disease, more severe liver scarring is linked to a higher rate of heart attacks and other cardiovascular events.
Among adults with metabolic dysfunction-associated steatotic liver disease, cardiovascular disease causes more deaths than any other condition.
Not medical advice. For informational purposes only. Always consult a qualified healthcare professional before making health decisions.