{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T01:01:19Z","timestamp":1788224479800,"version":"build-2803163510"},"reference-count":44,"publisher":"BMJ","issue":"6","license":[{"start":{"date-parts":[[2025,11,4]],"date-time":"2025-11-04T00:00:00Z","timestamp":1762214400000},"content-version":"unspecified","delay-in-days":3,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open Diab Res Care"],"accepted":{"date-parts":[[2025,10,18]]},"published-print":{"date-parts":[[2025,11]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Hepatic fibrosis caused by metabolic dysfunction-associated steatotic liver disease (MASLD) predicts adverse atherosclerotic cardiovascular disease (ASCVD) outcomes in the general patient population. However, it is unclear whether this association extends to type 2 diabetes mellitus (T2DM) patients, who have distinct metabolic profiles and high comorbidity of both MASLD and ASCVD. To address this gap, we investigated the association between hepatic fibrosis caused by MASLD and ASCVD risk in T2DM patients as well as potentially moderators of this association.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Research design and methods<\/jats:title>\n                    <jats:p>This multisite cross-sectional study included 1238 hospitalized T2DM patients with MASLD (mean age=57.81\u00b110.23, 37% female). Hepatic fibrosis was assessed via the Steatosis-Associated Fibrosis Estimator (SAFE) score, and 10-year ASCVD risk was assessed via the ASCVD Risk Calculator.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Advanced fibrosis was present in 25.6% of patients. Multivariable regression revealed a significant association between the SAFE score and 10-year ASCVD risk (p&lt;0.001), after adjusting for covariates. Each unit increase in SAFE score was associated with 0.07-unit increase in 10-year ASCVD risk score. Increase in SAFE score was associated with greater increase in 10-year ASCVD risk score among patients with hypertension, insulin resistance and elevated low-density lipoprotein (LDL) cholesterol (\n                      <jats:italic>p<\/jats:italic>\n                      s&lt;0.05). Overweight\/obesity, triglycerides, high-density lipoprotein cholesterol, uric acid, thyroid-stimulating hormone, hemoglobin A1c and high-sensitivity C reactive protein showed no moderating effects.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In T2DM patients, hepatic fibrosis caused by MASLD is associated with elevated ASCVD risks, particularly among those with hypertension, insulin resistance and elevated LDL cholesterol. It is crucial to incorporate hepatic fibrosis assessment into ASCVD risk stratification in T2DM patients with comorbid MASLD to inform early prevention of ASCVD.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjdrc-2025-005135","type":"journal-article","created":{"date-parts":[[2025,11,5]],"date-time":"2025-11-05T06:40:16Z","timestamp":1762324816000},"page":"e005135","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Metabolic factors moderate the association between hepatic fibrosis and atherosclerotic cardiovascular risk in type 2 diabetes"],"prefix":"10.1136","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5003-1698","authenticated-orcid":false,"given":"Lusi","family":"Lu","sequence":"first","affiliation":[{"name":"Department of Endocrinology and Metabolism, Zhejiang University School of Medicine, Sir Run Run Shaw Hospital, Hangzhou, Zhejiang, 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