Reply to: “Reassessing the causal relationship between liver diseases and cardiovascular outcomes” and “From liver to heart: Enhancing the understanding of cardiovascular outcomes in the UK Biobank”

We thank Xiang et al.[1] Xiang X. Wei Y. Zhao K. Reassessing the causal relationship between liver diseases and cardiovascular outcomes. J Hepatol. 2023; S0168-8278 (7): 5006https://doi.org/10.1016/j.jhep.2023.07.027 Abstract Full Text Full Text PDF Google Scholar and Zhang et al.[2] Zang Y. Pu J. Xie R. From Liver to Heart: Enhancing the Understanding of Cardiovascular Outcomes in the UK Biobank. J Hepatology. 2023; (JHEPAT-D-23-01549) Abstract Full Text Full Text PDF Google Scholar for their interest in our article on the independent associations between liver disease activity (measured by iron corrected T1-mapping (cT1)) and risk of new onset cardiovascular disease (CVD) events and all-cause mortality [3] Roca-Fernandez A. Banerjee R. Thomaides-Brears H. Telford A. Sanyal A. Neubauer S. et al. Liver disease is a significant risk factor for cardiovascular outcomes - a UK Biobank study. J Hepatol. 2023; S0168-8278 (8): 420https://doi.org/10.1016/j.jhep.2023.05.046 Abstract Full Text Full Text PDF Scopus (1) Google Scholar . Metabolic dysfunction-associated steatotic liver disease (MASLD) is the leading cause of morbidity and mortality from chronic liver disease (CLD) and is associated with increased CVD incidence and mortality [4] Mantovani A. Csermely A. Petracca G. Beatrice G. Corey K.E. Simon T.G. et al. Non-alcoholic fatty liver disease and risk of fatal and non-fatal cardiovascular events: an updated systematic review and meta-analysis. Lancet Gastroenterol Hepatol. 2021; 6: 903-913https://doi.org/10.1016/S2468-1253(21)00308-3 Abstract Full Text Full Text PDF PubMed Scopus (162) Google Scholar . Efforts to move away from using liver biopsy for MASLD diagnosis and replace with non-invasive tests are advocated by both clinicians and patients [5] Rinella ME, Lazarus JV, Ratziu V, Francque SM, Sanyal AJ, Kanwal F, et al. A multi-society Delphi consensus statement on new fatty liver disease nomenclature. Hepatology n.d.:10.1097/HEP.0000000000000520. https://doi.org/10.1097/HEP.0000000000000520. Google Scholar . Importantly, steatotic liver disease is mainly due to diet and environmental factors, not genetic risk – hence Mendelian randomisation for a condition that affects up to a third of UK adults is not suitable here. Reassessing the causal relationship between liver diseases and cardiovascular outcomesJournal of HepatologyPreviewWe read with great interest the study by Roca-Fernandez et al. which revealed the Liver disease activity(measured by iron corrected T1-mapping (cT1)) was independently associated with a higher risk of new onset cardiovascular diseases (CVDs) events and all-cause mortality using 33,616 participants from the UK Biobank (UKBB).1 Due to the inevitable limitations of observational study design, such as unidentified confounders and reverse causation, The results can hardly be interpreted as causal associations. Full-Text PDF From liver to Heart: Enhancing the understanding of cardiovascular outcomes in the UK BiobankJournal of HepatologyPreviewThe work was supported by Guangxi Science and Technology Project (Grant no.2021AC20006), and High-level personnel project of Affiliated Hospital of Youjiang Medical University for Nationalities (Grant no. R202210307). Full-Text PDF Liver disease is a significant risk factor for cardiovascular outcomes – A UK Biobank studyJournal of HepatologyPreviewChronic liver disease (CLD) is associated with increased cardiovascular disease (CVD) risk. We investigated whether early signs of liver disease (measured by iron-corrected T1-mapping [cT1]) were associated with an increased risk of major CVD events. Full-Text PDF Open Access