Systematic Reviews
Copyright ©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. May 27, 2025; 17(5): 105706
Published online May 27, 2025. doi: 10.4254/wjh.v17.i5.105706
Cardiovascular implications of metabolic dysfunction-associated fatty liver disease and type 2 diabetes mellitus: A meta-analysis
Sahana Shetty, Renuka Suvarna, Vanessa Ambrose Fistus, Shivam Modi, Joseph M Pappachan
Sahana Shetty, Renuka Suvarna, Department of Endocrinology, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal 576104, Karnataka, India
Vanessa Ambrose Fistus, Department of Medicine, Royal Preston Hospital, Lancashire Teaching Hospitals National Health Service Trust, Preston PR2 9HT, Lancashire, United Kingdom
Shivam Modi, Department of Endocrinology and Metabolism, Lancashire Teaching Hospitals National Health Service Trust, Preston PR2 9HT, Lancashire, United Kingdom
Joseph M Pappachan, Faculty of Science, Manchester Metropolitan University, Manchester M15 6BH, United Kingdom
Joseph M Pappachan, Department of Endocrinology, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, 576104, India
Author contributions: Shetty S and Pappachan JM participated in the design of the study; Suvarna R, Ambrose Fistus V and Modi S participated in the article screening and data extraction; The interpretation of the data and the statistical analysis was done by Suvarna R, Shetty S and Pappachan JM; Suvarna R, Shetty S, Ambrose Fistus V, Modi S and Pappachan JM drafted the manuscript and were involved in the revision process. All authors performed a review and approval of the final document.
Conflict-of-interest statement: Authors have no conflicts in interest to declare in relation to this manuscript.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Joseph M Pappachan, FRCP, MD, Professor, Senior Researcher, Faculty of Science, Manchester Metropolitan University, Manchester M15 6BH, United Kingdom. drpappachan@yahoo.co.in
Received: February 4, 2025
Revised: March 31, 2025
Accepted: April 22, 2025
Published online: May 27, 2025
Processing time: 112 Days and 10 Hours
Abstract
BACKGROUND

Metabolic dysfunction-associated fatty liver disease (MAFLD) and type 2 diabetes mellitus (T2DM) are independent risk factors for the development of cardiovascular disease (CVD) and an exaggerated CVD risk is expected when both diseases co-exist. Therefore, thorough risk stratification is important to inform better clinical practice decisions based on good quality evidence for patient with MAFLD and T2DM.

AIM

To identify the CVD and cardiovascular event (CVE) risk in a systematic review when MAFLD and T2DM co-exist to inform better clinical practice decisions.

METHODS

A systematic review was performed by compiling data by searching PubMed, EMBASE and Cochrane Library databases. Quality appraisal of retrieved studies and the meta-analysis were performed using Joanna Briggs Institute (JBI) tool and RevMan 5.4 software respectively. The effect indicators for CVE and CVD risk were expressed as odds ratios (OR) and 95%CI with P-values < 0.05 as significant.

RESULTS

Fourteen (5 cohort and 9 cross-sectional) studies with 370013 participants were included in this review. The meta-analysis of CVE showed that the risk of CVE in T2DM was higher in the MAFLD group when compared to the non-MAFLD group [OR 1.28 (95%CI, 1.04–1.56) P = 0.02] with follow up duration ranging between 5-6 years. The prevalence of CVD in the metanalysis of cross-sectional studies was found to be higher [OR 1.47 (95%CI, 1.21–1.78) P = 0.0001] in T2DM with MAFLD when compared to T2DM without MAFLD. Significant heterogeneity exists due to variations in study design, methodologies, and MAFLD diagnostic criteria, which may have influenced the study's findings.

CONCLUSION

The presence of MAFLD in T2DM increased the risk of CVE. The prevalence of CVD is higher in T2DM with MAFLD as compared to T2DM without MAFLD. Large well-designed multicentric long-term prospective studies are necessary to appropriately risk stratify the cardiovascular effect of the MAFLD in T2DM patients.

Keywords: Cardiovascular disease; Cardiovascular events; Insulin resistance; Metabolic dysfunction-associated fatty liver disease; Type 2 diabetes mellitus

Core Tip: Metabolic dysfunction-associated fatty liver disease (MAFLD) and type 2 diabetes mellitus (T2DM) are independent risk factors for the development of cardiovascular disease (CVD) with an exaggerated risk of cardiovascular events (CVE) when both diseases co-exist. A systematic review of fourteen studies with 370013 participants showed that the risk of CVE in T2DM was higher in the MAFLD group when compared to the non-MAFLD group [odds ratios (OR): 1.28] with follow up duration ranging between 5-6 years. The prevalence of CVD was higher (OR: 1.47) in T2DM with MAFLD when compared to T2DM without MAFLD. In conclusion, presence of MAFLD in T2DM increased the risk of CVE and CVD as compared to T2DM without MAFLD.