The role of MAFLD in predicting major adverse cardiovascular events in patients with stable COPD: a prospective cohort study.

Background: Cardiovascular disease is a major cause of morbidity and mortality in patients with chronic obstructive pulmonary disease (COPD). Metabolic dysfunction-associated fatty liver disease (MAFLD) is highly prevalent in COPD and reflects shared cardiometabolic and inflammatory pathways. However, its role in predicting cardiovascular outcomes within COPD populations remains insufficiently characterized. Methods: We conducted a prospective cohort study involving 168 patients with stable chronic obstructive pulmonary disease, with continued follow-up from a previously published report in the Vietnamese Journal of Medicine. Baseline MAFLD was defined using transient elastography in combination with metabolic criteria. Patients were followed for 12 months for the occurrence of first major adverse cardiovascular events (MACE). The analysis was structured as (1) an exposure-based analysis evaluating the association between MAFLD and MACE, and (2) an exploratory prognostic modeling approach using Bayesian Model Averaging, with model performance evaluated in terms of discrimination, calibration, clinical utility, and nomogram-based risk estimation. Results: During follow-up, 24 patients (14.3%) experienced MACE. MAFLD was significantly more frequent in patients with MACE than in those without (79.2% vs. 43.8%). In survival analysis, MAFLD was associated with shorter MACE-free survival and a more than fourfold increased risk of incident events. In Bayesian analyses, MAFLD showed the highest posterior inclusion probability, followed by dyspnoea severity assessed by the modified Medical Research Council scale. A multivariable model incorporating MAFLD, mMRC, and high-sensitivity C-reactive protein showed fair-to-acceptable discrimination (AUC ≈ 0.75) with internal calibration assessment and was used to derive an exploratory nomogram for 12-month MACE risk estimation. Conclusion: In patients with stable COPD, MAFLD is a strong and consistent predictor of 12-month MACE. These findings suggest that cardiovascular risk stratification in COPD populations may benefit from incorporating cardiometabolic comorbidities, particularly MAFLD. A Bayesian model incorporating MAFLD, mMRC, and hs-CRP showed preliminary discriminatory ability for 12-month cardiovascular risk stratification, but requires external validation before clinical use.