Journal of the American Heart Association · 2026
Association of Metabolic Dysfunction-Associated Steatotic Liver Disease With Features of Cerebral Small-Vessel Disease on Magnetic Resonance Images: A Large Cross-Sectional Study.
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Wang Yaqin, Chen Kui, Wang Changfa, Hu Zhongyang, Zhu Xiaoling, Liu Lei
Аннотация
BACKGROUND: We examined the associations between metabolic dysfunction-associated steatotic liver disease (MASLD) and cerebral small-vessel disease burden manifested on magnetic resonance images in a population of Chinese individuals undergoing a healthy checkup.
METHODS: In this cross-sectional study, 7679 participants (aged ≥18 years) with brain magnetic resonance imaging data from Hunan Province, China, were enrolled between 2017 and 2023. The cerebral small-vessel disease burden was measured using markers on magnetic resonance images, including total white matter hyperintensity (WMH), 4 WMH spatial patterns (deep WMH, periventricular, juxtacortical WMH, and juxtaventricular WMH), lacunes, cerebral microbleeds, and enlarged perivascular space. Multiple linear and ordinal/binary logistic regression models were used for liver-brain associations, and separate models were created for subgroup analyses. The role of cardiovascular metabolism-related mediators was estimated using mediation analysis.
RESULTS: MASLD was significantly associated with a greater volume of total WMH (including 2 unique spatial patterns: deep WMH and periventricular WMH) and a greater burden of lacunes. The relationships between MASLD and cerebral microbleeds or enlarged perivascular space were not significant. Stratified analyses revealed that the liver-brain association (MASLD and total WMH volume or lacunar lesions) was affected by hypertension (P-interaction <0.05). Moreover, blood pressure had the greatest mediating effect among cardiovascular metabolic risks. The mediation proportions with SBP and DBP were 11.67% and 12.67%, respectively, for total WMH volume and 12.37% and 10.87%, respectively, for lacunes.
CONCLUSIONS: Our study revealed a close link between MASLD and cerebral small-vessel disease in terms of neuroimaging features. Individuals with MASLD, especially those accompanied by hypertension, should be encouraged to undergo screening for cerebral small-vessel disease risk to facilitate the prediction of brain aging burden.
METHODS: In this cross-sectional study, 7679 participants (aged ≥18 years) with brain magnetic resonance imaging data from Hunan Province, China, were enrolled between 2017 and 2023. The cerebral small-vessel disease burden was measured using markers on magnetic resonance images, including total white matter hyperintensity (WMH), 4 WMH spatial patterns (deep WMH, periventricular, juxtacortical WMH, and juxtaventricular WMH), lacunes, cerebral microbleeds, and enlarged perivascular space. Multiple linear and ordinal/binary logistic regression models were used for liver-brain associations, and separate models were created for subgroup analyses. The role of cardiovascular metabolism-related mediators was estimated using mediation analysis.
RESULTS: MASLD was significantly associated with a greater volume of total WMH (including 2 unique spatial patterns: deep WMH and periventricular WMH) and a greater burden of lacunes. The relationships between MASLD and cerebral microbleeds or enlarged perivascular space were not significant. Stratified analyses revealed that the liver-brain association (MASLD and total WMH volume or lacunar lesions) was affected by hypertension (P-interaction <0.05). Moreover, blood pressure had the greatest mediating effect among cardiovascular metabolic risks. The mediation proportions with SBP and DBP were 11.67% and 12.67%, respectively, for total WMH volume and 12.37% and 10.87%, respectively, for lacunes.
CONCLUSIONS: Our study revealed a close link between MASLD and cerebral small-vessel disease in terms of neuroimaging features. Individuals with MASLD, especially those accompanied by hypertension, should be encouraged to undergo screening for cerebral small-vessel disease risk to facilitate the prediction of brain aging burden.