Abstract
This study aimed to investigate the relationship between liver stiffness measurements (LSM), controlled attenuation parameter (CAP), and coronary heart disease (CHD) using data from the National Health and Nutrition Examination Survey (NHANES). A total of 12,684 American populations who underwent health examinations were included from the NHANES database spanning 2017-2020 (pre-pandemic) and 2021-2023. Logistic regression was employed to analyze the associations between LSM, CAP, and CHD. Restricted cubic spline (RCS) regression was used to evaluate the dose-response relationship between LSM, CAP, and CHD. Stratified analyses were performed according to age, sex, race, education level, income, BMI, blood pressure, hepatitis B surface antibody, and cholesterol to explore potential interactions and identify specific subpopulations at risk. Finally, predictive models were developed using logistic regression, decision trees, XGBoost classifiers, and neural networks to assess the predictive value of LSM and CAP for CHD risk. During the study period, 12,684 participants were included, of whom 539 (4.24%) were diagnosed with CHD. After adjusting for confounders, both LSM and CAP were found to be significantly positively associated with CHD risk in U.S. adults. Subgroup analyses revealed a significant positive association between LSM and CHD incidence in participants stratified by race and blood parameters (interaction P-value < 0.050). Additionally, sex, age, and lipid profiles showed a significant positive correlation between CAP and CHD risk. Predictive models also indicated a positive relationship between LSM, CAP, and CHD risk. Both LSM and CAP were nonlinearly and positively associated with CHD risk, highlighting the importance of maintaining lower levels of liver stiffness and fat as a potential preventive strategy for CHD.