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HS and CAD endpoints were defined on coronary CT. MACE was defined as unstable angina, non\u2010fatal myocardial infarction, and all\u2010cause death. Multivariable Cox regression, adjusting for CAD characteristics, assessed the association of HS with MACE for ASCVD &lt;\u20097.5%.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>One thousand two hundred and four of 3702 (32.5%) patients were at ASCVD &lt;\u20097.5% and 20.3% (244\/1204) of them had HS. Individuals with HS were younger (54.3\u2009\u00b1\u20095.2 vs. 55.8\u2009\u00b1\u20095.2; <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001), more often males (40.2% [98\/244] vs. 27.1% [260\/960]; <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001), had more risk factors\/person (2.06\u2009\u00b1\u20090.89 vs. 1.93\u2009\u00b1\u20090.91; <jats:italic>p<\/jats:italic>\u2009=\u20090.047). CAD characteristics were similar between HS vs. non\u2010HS patients at ASCVD &lt;\u20097.5% and ASCVD \u2265\u20097.5% (all <jats:italic>p<\/jats:italic>\u2009&gt;\u20090.05). Patients with HS had greater MACE rate compared to non\u2010HS patients (ASCVD &lt;\u20097.5%: 3.75%[9\/244] vs. 1.5% [14\/960]; <jats:italic>p<\/jats:italic>\u2009=\u20090.027 and ASCVD \u2265\u20097.5%: 4.7% [33\/696] vs. 3.1% [56\/1802]; <jats:italic>p<\/jats:italic>\u2009=\u20090.043). In patients without HS, MACE rate was higher in the ASCVD \u2265\u20097.5% vs. &lt;\u20097.5% (3.1% [56\/1802] vs. 1.5% [14\/960]; <jats:italic>p<\/jats:italic>\u2009=\u20090.011). In patients with HS, MACE rates were not significantly different between ASCVD \u2265\u20097.5% vs. &lt;\u20097.5% (4.7% [33\/696] vs. 3.7% [9\/244]; <jats:italic>p<\/jats:italic>\u2009=\u20090.484). In ASCVD &lt;\u20097.5%, HS predicted MACE (aHR:2.34, 95%CI:1.01\u20135.43; <jats:italic>p<\/jats:italic>\u2009=\u20090.048), independent of CAD characteristics.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Individuals with HS at ASCVD &lt;\u20097.5% risk had similar CAD characteristics as patients without HS at &lt;\u20097.5% ASCVD risk, yet experienced comparable MACE rates as those at ASCVD \u2265\u20097.5%.<\/jats:p><\/jats:sec>","DOI":"10.1111\/apt.18415","type":"journal-article","created":{"date-parts":[[2024,11,29]],"date-time":"2024-11-29T08:18:18Z","timestamp":1732868298000},"page":"558-569","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Coronary Artery Disease and Major Adverse Cardiovascular Events in People With Hepatic Steatosis at Low Atherosclerotic Cardiovascular Disease Risk"],"prefix":"10.1111","volume":"61","author":[{"given":"Julia","family":"Karady","sequence":"first","affiliation":[{"name":"Cardiovascular Imaging Research Center Harvard Medical School\u2014Massachusetts General Hospital  Boston Massachusetts USA"},{"name":"Heart and Vascular Center Semmelweis University  Budapest Hungary"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Thomas","family":"Mayrhofer","sequence":"additional","affiliation":[{"name":"Cardiovascular Imaging Research Center Harvard Medical School\u2014Massachusetts General Hospital  Boston Massachusetts USA"},{"name":"School of Business Studies Stralsund University of Applied Sciences  Stralsund Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Borek","family":"Foldyna","sequence":"additional","affiliation":[{"name":"Cardiovascular Imaging Research Center Harvard Medical School\u2014Massachusetts General Hospital  Boston Massachusetts USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael T.","family":"Lu","sequence":"additional","affiliation":[{"name":"Cardiovascular Imaging Research Center Harvard Medical School\u2014Massachusetts General Hospital  Boston Massachusetts USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nandini","family":"Meyersohn","sequence":"additional","affiliation":[{"name":"Cardiovascular Imaging Research Center Harvard Medical School\u2014Massachusetts General Hospital  Boston Massachusetts USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Udo","family":"Hoffmann","sequence":"additional","affiliation":[{"name":"Cardiovascular Imaging Research Center Harvard Medical School\u2014Massachusetts General Hospital  Boston Massachusetts USA"},{"name":"Cleerly Inc.  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