Diabetes/metabolism research and reviews · 2026
Agile 3+ Index Is Independently Associated With Cardiovascular Diseases in Patients With Metabolic Dysfunction-Associated Steatotic Liver Disease: Analysis of NHANES 2017-2020.
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Li Yan, Yang Minglan, Yue Jiang, Wang Zixuan, Qi Yicheng, Liu Qianjing, Ma Jing
Аннотация
BACKGROUND: The Agile 3+ score, recently developed based on transient elastography measurements, transaminase ratios, and metabolic parameters, effectively assesses fibrosis in metabolic dysfunction-associated steatotic liver disease (MASLD). This study aimed to evaluate the association between Agile 3+ and cardiovascular diseases (CVD) in MASLD and to compare its predictive performance with Agile 4, Fibrosis-4 (FIB-4), and FibroScan aspartate aminotransferase (FAST).
METHODS: We analysed data in 3198 patients with MASLD during the 2017-March 2020 prepandemic from National Health and Nutrition Examination Survey. The associations between Agile 3+ and CVD were assessed using univariate and multivariable logistic regression models. Predictive accuracy was evaluated via receiver operating characteristic curves and decision curve analysis (DCA).
RESULTS: Among 3198 patients with MASLD, 385 (12.0%) had CVD. After adjusting for confounders, a dose-dependent relationship was observed between Agile 3+ and CVD risk: compared to the reference group, the odds of CVD increased by 58% in the 0.45-0.68 group (OR 1.58, 95%CI 1.13-2.20, p = 0.008) and by 78% in the ≥ 0.68 group (OR 1.78, 95%CI 1.22-2.59, p = 0.003). In the context of CVD risk prediction, Agile 3+ and FIB-4 achieved the highest AUC (0.71), outperforming Agile 4 (0.64) and FAST (0.51). DCA revealed that Agile 3+ provided superior net benefit within the 20%-40% CVD risk threshold range. Furthermore, subgroup and sensitivity analyses further confirmed the robustness of the results.
CONCLUSIONS: Agile 3+ is independently associated with CVD in patients with MASLD and demonstrates better predictive performance than Agile 4, FIB-4, and FAST scores.
METHODS: We analysed data in 3198 patients with MASLD during the 2017-March 2020 prepandemic from National Health and Nutrition Examination Survey. The associations between Agile 3+ and CVD were assessed using univariate and multivariable logistic regression models. Predictive accuracy was evaluated via receiver operating characteristic curves and decision curve analysis (DCA).
RESULTS: Among 3198 patients with MASLD, 385 (12.0%) had CVD. After adjusting for confounders, a dose-dependent relationship was observed between Agile 3+ and CVD risk: compared to the reference group, the odds of CVD increased by 58% in the 0.45-0.68 group (OR 1.58, 95%CI 1.13-2.20, p = 0.008) and by 78% in the ≥ 0.68 group (OR 1.78, 95%CI 1.22-2.59, p = 0.003). In the context of CVD risk prediction, Agile 3+ and FIB-4 achieved the highest AUC (0.71), outperforming Agile 4 (0.64) and FAST (0.51). DCA revealed that Agile 3+ provided superior net benefit within the 20%-40% CVD risk threshold range. Furthermore, subgroup and sensitivity analyses further confirmed the robustness of the results.
CONCLUSIONS: Agile 3+ is independently associated with CVD in patients with MASLD and demonstrates better predictive performance than Agile 4, FIB-4, and FAST scores.