MASLD and Cardiovascular Risk: Mechanisms and Implications for Clinical Practice

Abstract

Metabolic dysfunction-associated steatotic liver disease (MASLD) is increasingly recognized as a systemic cardiometabolic disease. This review summarizes recent advances in epidemiology, pathophysiology, biomarkers, and treatment relevant to cardiovascular risk assessment and management. Fibrosis stage is the strongest independent predictor of cardiovascular outcomes in MASLD, conferring up to a 2.5-fold increase in events beyond traditional risk factors. Noninvasive tools, including Fibrosis-4 (FIB-4) and liver stiffness measurement, also predict cardiovascular mortality. Semaglutide and resmetirom offer dual hepatic and cardiometabolic benefits. MASLD affects 38% of adults globally, and cardiovascular disease (CVD) is the leading cause of death across disease stages. Fibrosis-based risk stratification remains absent from standard cardiovascular risk models despite its prognostic value. Therapies with combined liver and cardiovascular benefits are promising, but whether improving liver disease reduces cardiovascular events remains uncertain.