Metabolic dysfunction-associated steatotic liver disease (MASLD), previously termed non-alcoholic fatty liver disease (NAFLD) is a consequential and increasingly prevalent manifestation of the obesity epidemic. While the natural history of MASLD may progress to metabolic dysfunction-associated steatohepatitis (MASH), fibrosis and, in some cases, cirrhosis, most patients with MASLD do not die from liver-related complications but rather from cardiovascular events. 1 This strong epidemiological association has fuelled an ongoing debate in hepatology and cardiology: does MASLD independently increase cardiovascular risk beyond established risk factors, or is it primarily a manifestation of shared risk pathways? This paper discusses relevant evidence from multiple angles to argue that MASLD presently cannot be considered an independent CV risk factor but that patients with MASLD represent a high-risk group who should be screened for CV risk factors to allow for holistic risk reduction.
Sattar et al. (2026) studied this question.