A study of 103 patients with metabolic dysfunction-associated steatotic liver disease (MASLD) found that cirrhosis and elevated levels of the intestinal fungus Candida albicans independently predict subclinical coronary atherosclerosis.
How gut fungal changes relate to liver and heart risk
Researchers analyzed fecal samples and imaging data from MASLD patients without established cardiovascular disease. They measured liver fibrosis using magnetic resonance elastography, fat content via proton density fat fraction, and coronary artery calcification as a marker of subclinical coronary atherosclerosis.
Candida albicans abundance was significantly higher in patients with cirrhosis and correlated with both coronary artery calcification scores (r = 0.403, p < 0.001) and liver fibrosis (r = 0.212, p = 0.032). In multivariate analysis, older age, diabetes, obesity, cirrhosis, and enriched Candida albicans independently predicted a coronary artery calcification score of 100 Agatston units or higher.
Why this finding changes risk assessment in MASLD
The study identifies intestinal fungal dysbiosis as a novel factor linked to both MASLD progression and cardiovascular risk. Prior research had focused on gut bacteria, but this is the first report associating specific fungi with the severity of liver disease and subclinical coronary atherosclerosis in MASLD patients.
These results suggest that evaluating gut mycobiome could improve risk stratification for cardiovascular events in MASLD, particularly in those with advanced liver fibrosis, even before symptoms appear.
What is MASLD and how is it linked to heart disease?
MASLD, or metabolic dysfunction-associated steatotic liver disease, is a condition characterized by excess fat in the liver not due to alcohol use. It is an independent risk factor for cardiovascular disease, sharing common pathways like insulin resistance, inflammation, and oxidative stress.
How was subclinical coronary atherosclerosis measured in the study?
Subclinical coronary atherosclerosis was defined by the presence of coronary artery calcification, detected through imaging, and quantified as a score in Agatston units.