New study shows high blood pressure is deadlier than diabetes in fatty liver disease

If you thought diabetes was the biggest threat to those with fatty liver disease, think again. In a startling turn of medical understanding, scientists at the University of Southern California have uncovered a trio of cardiometabolic culprits responsible for most deaths in patients suffering from the world’s most common liver condition — Metabolic dysfunction-associated steatotic liver disease (MASLD). Affecting more than a third of the global population, MASLD has long flown under the radar, but this new research is shining an urgent light on the real dangers hiding in plain sight.

Researchers from Keck Medicine of USC analysed over 30 years of health data and uncovered a surprising truth—high blood pressure, not diabetes, is the most fatal risk factor for people living with MASLD. The study, published in Clinical Gastroenterology and Hepatology, shows that high blood pressure increases the risk of death by 40%, followed by diabetes (25%) and low levels of HDL, or “good” cholesterol (15%). Even more revealing, these dangers held true regardless of the patient’s gender, race or ethnicity. It's the kind of revelation that could reshape how doctors approach fatty liver treatment — and save lives in the process.

Also Read: Non-alcoholic fatty liver disease in children: How reducing stress, obesity, and poor diet minimise risk

The study makes one thing clear—having just one of these conditions is bad, but having more than one, is deadly. Here’s what the study found:

• High blood pressure – Most dangerous of all, increasing mortality by a staggering 40%.


• Diabetes (Type 2 or prediabetes) – Boosts death risk by 25%, less than expected.


• Low HDL cholesterol – Often overlooked, yet raises death odds by 15%.


• Obesity/BMI – Not among the top three killers, but still a major player. The higher the BMI, the higher the risk.


• Multiple risk factors – Every additional condition increased risk of death by another 15%.

“Until now, diabetes was seen as the main problem,” said lead author Dr Matthew Dukewich. “But we were surprised to find that blood pressure posed an even greater threat.” This misjudgement, he suggests, could be why many MASLD patients weren’t getting the targeted care they needed — and why this study is such a wake-up call for the medical community

Dr Norah Terrault, senior author of the study, believes the findings should prompt a shift in how MASLD is treated. “Knowing what drives poor outcomes lets us better focus our efforts,” she explained.