Incidental steatotic liver in young patients with ischemic stroke: A marker of high vascular burden and underrecognized prevention opportunity.

BACKGROUND

Ischemic stroke in adults younger than 60 years often occurs in the setting of underrecognized cardiometabolic risk.

OBJECTIVE AND

METHODS

We conducted a retrospective cohort study of 323 patients of <60 years admitted with ischemic stroke (2021-2025) to evaluate whether incidentally detected fatty liver is associated with subclinical vascular disease and lipid-lowering therapy use.

RESULTS

Fatty liver was identified in 26% of patients and was associated with higher triglycerides, diabetes, and antihypertensive use. Vascular calcification in any bed was more prevalent among those with fatty liver (84.5% vs. 66.9%, P = 0.002) with significant associations across coronary, carotid, thoracic aortic and valvular sites. In multivariable analysis, fatty liver remained independently associated with vascular calcification (OR 2.94, P = 0.009). Despite this, lipid-lowering therapy use was low overall (32.8%) not independently associated with fatty liver or calcification.

CONCLUSION

These findings suggest fatty liver is an underrecognized marker of vascular risk and highlight a gap between imaging-detected disease burden and preventive treatment in younger stroke patients.