Various subtypes of steatotic liver disease (SLD) have been proposed to better capture its clinical spectrum. Previous studies have linked both prolonged antibiotic use and metabolic dysfunction-associated SLD (MASLD) with an increased risk of cardiovascular disease (CVD). This study examined the combined impact of antibiotic use on CVD risk among patients with MASLD.
Using data from 276,520 adults aged 40 and older in the Korean National Health Insurance Service database, antibiotic exposure was assessed based on cumulative prescription days and the number of antibiotic classes. Participants were categorized into MASLD and non-SLD groups, with hepatic steatosis defined as a fatty liver index ≥60.
During the follow-up period from 2013 to 2019, a total of 16,197 CVD cases were identified. A multivariate Cox proportional hazards model, adjusted for relevant covariates, was used to estimate adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs) for CVD risk. MASLD patients who were prescribed antibiotics for ≥91 days had a significantly higher risk of CVD (aHR 1.56; 95% CI, 1.39–1.74) compared to non-users without SLD. Similarly, those prescribed ≥4 classes of antibiotics also showed increased risk (aHR 1.49; 95% CI, 1.34–1.66) compared to non-users without SLD. These findings remained consistent across sensitivity analyses. In summary, prolonged antibiotic exposure may elevate the risk of CVD in MASLD patients, underscoring the need for cautious antibiotic use and further research to deepen the understanding of these intricate relationships.