Nutr Metab Cardiovasc Dis. 2026 Sep 29:105013. doi: 10.1016/j.numecd.2026.105013. Online ahead of print.
ABSTRACT
BACKGROUND AND AIMS: Low 10-year ASCVD risk can coexist with substantial long-horizon risk in younger adults. The 2026 dyslipidemia guideline introduced 30-year PREVENT-ASCVD risk ≥10% as a criterion for considering moderate-intensity statin therapy in adults aged 30-59 years with 10-year risk <3%. We aimed to quantify the population scale and incremental classification reach of this criterion among U.S. adults with metabolic dysfunction-associated steatotic liver disease (MASLD).
METHODS AND RESULTS: We analyzed NHANES 2017-March 2020 and August 2021-August 2023 as independent complex surveys. Adults aged 30-59 years with VCTE-defined operational MASLD, no clinical ASCVD, no lipid-lowering therapy, LDL-C 70-189 mg/dL, no observable automatic-treatment indication, and 10-year PREVENT-ASCVD risk <3% were included. G1 was defined as 30-year risk ≥10% with LDL-C <160 mg/dL. The complete primary cores included 529 and 303 participants. G1 prevalence was 33.3% and 27.9%, representing 5.85 and 4.50 million U.S. adults. Among participants leaving G0 through either the long-horizon or LDL-C 160-189 mg/dL criterion, 85.7% and 75.1% were identified uniquely by 30-year risk. In the broader operational MASLD pathway, G1 accounted for 15.8% and 13.9% of the weighted distribution and was more concentrated than in confirmed non-MASLD. Findings were stable across alternative specifications and neighboring thresholds.
CONCLUSION: Among adults with operational MASLD who remained at low 10-year ASCVD risk, the 30-year PREVENT criterion identified a substantial population not captured by the parallel LDL-C 160-189 mg/dL pathway and accounted for most downstream classification beyond G0. These findings define the disease-specific population reach of long-horizon risk assessment in MASLD.
CLINICAL TRIAL REGISTRATION: Not applicable.
PMID:42897040 | DOI:10.1016/j.numecd.2026.105013