A Multidimensional Assessment of Cardiometabolic Risk in Asian Americans with Chronic Hepatitis B Using the All of Us Datasets

Background/Objectives: Asian Americans (AAs) bear a disproportionate burden of chronic hepatitis B (CHB), with one in 12 living with this condition. Despite evidence that cardiometabolic conditions accelerate CHB progression and hepatocellular carcinoma risk, cardiometabolic comorbidities in this population remain critically understudied. This study provides an assessment of cardiometabolic burden and phenotypic heterogeneity among AAs with CHB. Methods: We analyzed data from the All of Us Research Program Controlled Tier Dataset v8 (n = 436 AAs with CHB). We ran descriptive analyses to examine four cardiometabolic conditions (hypertension, type 2 diabetes mellitus [T2DM], dyslipidemia, and central obesity). Unsupervised clustering (k-prototypes and k-modes) identified cardiometabolic phenotypes in the overall sample and stratified by sex and age. Multinomial logistic regression examined sociodemographic predictors of cluster membership. Results: Cardiometabolic burden was substantial: 38.76% had hypertension, 25.46% dyslipidemia, 17.66% T2DM, and 16.74% central obesity. Nearly two-thirds (61.93%) had at least one cardiometabolic condition, and over one-quarter (28.90%) had two or more. Cluster analysis identified three phenotypes: “Young/Healthy” (54.6%), “Dyslipidemia-Dominant” (19.7%), and “Hypertension-Dominant” (25.7%). Sex- and age-stratified analyses revealed divergent metabolic profiles not apparent in the overall solution. Conclusions: AAs with CHB carry a high and heterogeneous cardiometabolic burden. Integrated metabolic screening and sex- and age-informed prevention strategies may be warranted for this high-risk population, though prospective validation is needed to establish the clinical utility of these phenotypes.