Link between Metabolic Dysfunction-Associated Steatotic Liver Disease and Cardiovascular Diseases

Epidemiological and clinical evidence increasingly highlights a close association between metabolic dysfunction-associated steatotic liver disease (MASLD) and cardiovascular disease (CVD). The transition from nonalcoholic fatty liver disease (NAFLD) to MASLD represents a conceptual shift toward a metabolism-centered framework with important implications for cardiovascular risk assessment. As the global burden of both conditions continues to rise, clarifying their bidirectional relationship has become increasingly important. This review summarizes current epidemiological and clinical evidence linking MASLD to adverse cardiovascular outcomes and discusses the potential value of liver-specific markers, particularly fibrosis indices, in cardiovascular risk stratification beyond traditional risk factors. Mechanistically, we examine shared upstream metabolic mechanisms linking MASLD and CVD, as well as the bidirectional liver-heart axis involving liver-to-heart effects and cardiovascular feedback to the liver. We further summarize key molecular mediators involved in these processes and their potential relevance to both cardiovascular and hepatic injury. Finally, we discuss the clinical and therapeutic implications of this integrated framework, including the potential to achieve dual hepatic and cardiovascular benefit. A clearer understanding of the MASLD-CVD interplay may support earlier detection, more precise risk stratification, and multidisciplinary management.