10-YEAR RISK OF CVD IN PATIENTS WITH METABOLIC SYNDROME WITH AND WITHOUT NAFLD

Background: Metabolic syndrome is a major cardiometabolic disorder that increases the likelihood of future cardiovascular disease through clustered abnormalities such as central obesity, hypertension, dyslipidemia, and impaired glucose regulation. Non-alcoholic fatty liver disease commonly coexists with metabolic syndrome and may further increase cardiovascular risk through inflammation, insulin resistance, and endothelial dysfunction. However, liver status is not routinely included in conventional cardiovascular risk prediction tools, which may underestimate risk in affected patients. Objective: To compare the estimated 10-year cardiovascular disease risk among patients with metabolic syndrome with and without non-alcoholic fatty liver disease and to determine whether non-alcoholic fatty liver disease independently predicts higher cardiovascular risk. Methods: This cross-sectional observational study included 100 patients with metabolic syndrome, divided equally into two groups: metabolic syndrome with ultrasound-confirmed non-alcoholic fatty liver disease and metabolic syndrome without fatty liver on ultrasound. Demographic, clinical, and biochemical variables were recorded, including age, sex, waist circumference, blood pressure, triglycerides, high-density lipoprotein cholesterol, and fasting glucose. The 10-year cardiovascular disease risk was estimated using the Framingham Risk Score and ASCVD Risk Estimator. Group comparisons, correlation analysis, and multivariable regression analysis were performed. Results: The mean Framingham Risk Score was significantly higher in patients with non-alcoholic fatty liver disease than in those without it (22.4 ± 8.2% versus 16.3 ± 7.6%, p = 0.03). Similarly, the mean ASCVD risk was higher in the non-alcoholic fatty liver disease group (24.1 ± 9.1% versus 18.9 ± 7.5%, p = 0.04). High cardiovascular risk was observed in 60% of patients with non-alcoholic fatty liver disease compared with 36% without it (p = 0.01). Fatty liver grade showed a positive correlation with Framingham Risk Score (r = 0.45, p = 0.01) and ASCVD risk (r = 0.42, p = 0.02). Multivariable regression showed that non-alcoholic fatty liver disease independently predicted higher Framingham Risk Score (β = 0.32, p = 0.02) and ASCVD risk (β = 0.29, p = 0.03). Conclusion: Non-alcoholic fatty liver disease was associated with higher estimated 10-year cardiovascular disease risk among patients with metabolic syndrome. Routine liver assessment may improve cardiovascular risk stratification and help identify patients who may benefit from earlier preventive intervention. Keywords: Atherosclerosis; Cardiovascular Diseases; Fatty Liver; Framingham Study; Metabolic Syndrome; Risk Assessment; Ultrasonography.