Metabolic Dysfunction–Associated Steatotic Liver Disease: An Underrated and Emerging Cardiovascular Risk Factor

Abstract

Metabolic dysfunction-associated steatotic liver disease (MASLD) is the most prevalent chronic liver disease worldwide and is increasingly recognized as a major contributor to cardiovascular morbidity and mortality. Beyond liver involvement, MASLD represents a systemic metabolic disorder closely linked to cardiovascular disease (CVD), the leading cause of death in affected patients. This association persists independently of traditional cardiometabolic risk factors and is driven by multiple mechanisms, including insulin resistance, chronic low-grade inflammation, atherogenic dyslipidemia, endothelial dysfunction, and prothrombotic states. Disease severity, particularly liver fibrosis, appears to further increase cardiovascular risk. This review summarizes current evidence on the epidemiological and pathophysiological links between MASLD and CVD, including its role in atherosclerosis, coronary artery disease, and heart failure. Clinical implications for cardiovascular risk stratification, screening, and multidisciplinary management are also discussed, highlighting the need for integrated strategies to reduce both hepatic and cardiovascular complications.