Cardiovascular risk assessment tools are insufficient for patients with metabolic dysfunction associated steatotic liver disease.

Challenge

Standard cardiovascular risk prediction tools, the Framingham Risk Score, Pooled Cohort Equations, and AHA PREVENT, were derived from general populations and have never been validated specifically in MASLD, a condition where CV death is the leading cause of mortality. Their discriminatory performance and calibration in patients with progressive liver disease across the MASLD spectrum was unknown.

Solution

The longitudinal TARGET-NASH cohort provided over 5 years of prospectively tracked CV events and liver disease staging across more than 1,000 patients, enabling head-to-head evaluation of multiple risk models against observed outcomes, a validation study architecture that requires the kind of persistent, multi-site real-world follow-up that Target RWE's infrastructure uniquely supports.

Impact

Demonstrating that standard CV risk tools systematically miscalibrate in MASLD patients, both over- and underestimating risk depending on disease severity, provides direct evidence that MASLD should be treated as an independent CV risk modifier, supporting a clinical and regulatory case for MASLD-specific risk stratification in both treatment guidelines and cardiovascular endpoint design for MASLD trials.