The impact of metabolic dysfunction-associated steatotic liver disease (MASLD), the preferred nomenclature for NAFLD, on cardiovascular health and mortality among older adults is uncertain. As such, we aimed to identify whether MASLD increases the risk of Major Adverse Cardiovascular Events (MACE) (a composite of fatal coronary heart disease [excluding heart failure], nonfatal myocardial infarction, or fatal or nonfatal ischemic stroke), Atrial Fibrillation (AF), or all-cause mortality in older adults, and whether aspirin attenuates these risks in individuals with MASLD. This is a non-prespecified post-hoc analysis of the ASPREE (ASPirin in Reducing Events in the Elderly) randomized trial. Participants were community dwelling well adults aged ≥ 70 years without a history of atherosclerotic cardiovascular disease or AF. Fatty Liver Index (FLI) was used to identify MASLD at baseline. FLI is a composite of anthropometric and biochemical markers used in epidemiologic studies to rule in and rule out hepatic steatosis. MACE and cause of death were adjudicated by clinical experts; AF was assessed by previously defined algorithm in ASPREE. 9,097 participants were stratified into groups according to FLI. In univariate analysis, prevalent MASLD (FLI ≥ 60 with evidence of metabolic dysfunction; n = 2,998 [33.0%]) was associated with an increased risk of MACE (HR 1.47 [95% CI 1.22–1.78]) and AF (HR 1.50 [95% CI 1.19–1.88] but not all-cause mortality (HR 1.04 [95% CI 0.91–1.19]). After adjusting for cardiovascular disease risk factors, only the association between MASLD and AF remained significant (HR 1.46 [95% CI 1.11–1.93]). Aspirin did not reduce the risk of MACE, death, or AF in the MASLD group. MASLD was associated with an increased hazard of incident AF, but not of MACE or all-cause mortality, in community dwelling older adults. Primary prevention with aspirin does not ameliorate these risks in older adults with MASLD.

代谢功能障碍相关脂肪性肝病 （MASLD） 是 NAFLD 的首选命名法，对老年人心血管健康和死亡率的影响尚不确定。因此，我们旨在确定 MASLD 是否会增加主要不良心血管事件 （MACE） （致命性冠心病 [不包括心力衰竭]、非致命性心肌梗死或致命性或非致命性缺血性中风的复合）、心房颤动 （AF） 或老年人全因死亡率的风险，以及阿司匹林是否减轻了 MASLD 患者的这些风险。这是对 ASPREE（减少老年人事件中的 ASPirin）随机试验的非预先指定的事后分析。参与者是 70 ≥ 岁的社区居住健康成年人，没有动脉粥样硬化性心血管疾病或 AF 病史。脂肪肝指数 （FLI） 用于识别基线时的 MASLD。FLI 是人体测量学和生化标志物的复合体，用于流行病学研究，用于排除肝脂肪变性。MACE 和死因由临床专家裁决;AF 通过 ASPREE 中先前定义的算法进行评估。根据 FLI 将 9,097 名参与者分为几组。在单变量分析中，普遍的 MASLD （FLI ≥ 60 有代谢功能障碍的证据;n = 2,998 [33.0%]）与 MACE （HR 1.47 [95% CI 1.22–1.78]）和 AF （HR 1.50 [95% CI 1.19–1.88] 相关，但与全因死亡率 （HR 1.04 [95% CI 0.91–1.19]） 无关。在调整了心血管疾病危险因素后，只有 MASLD 和 AF 之间的关联仍然显著 （HR 1.46 [95% CI 1.11–1.93]）。阿司匹林没有降低 MASLD 组发生 MACE、死亡或 AF 的风险。 MASLD 与社区老年人发生 AF 的风险增加有关，但与 MACE 或全因死亡率无关。阿司匹林的一级预防并不能改善 MASLD 老年的这些风险。