, Domenico Mario Giamundo 2
, Giuseppe Ando 3
, Piera Capranzano 4
, Luigi Spadafora 5
, Stefano Cacciatore 6
, Felice Gragnano 7
, Marco Bernardi 5
, Elad Asher 8
, Michael D. Shapiro 9
, Irene Cacciola 10
, Dan Atar 11
, Atul Pathak 12
2Division of Cardiology, Policlinico Casilino, Rome, Italy
3Department of Clinical and Experimental Medicine, University of Messina and Azienda, Messina, Italy
4Department of Cardiovascular, Ferrarotto Hospital, University of Catania, Catania, Italy
5Departments of Clinical, Internal Medicine, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
6Departments of Geriatrics, Orthopedics and Rheumatology, Università Cattolica del Sacro Cuore, Rome, Italy
7Department of Translational Medical Sciences, University of Campania ‘Luigi Vanvitelli’, Caserta - University Cardiology Unit, Cardiovascular Department, Caserta, Italy
8Jesselson Heart Center, Shaare Zedek Medical Center, The Eisenberg R&D Authority, and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
9Center for Preventive Cardiology, Section On Cardiovascular Medicine, Wake Forest University Baptist Medical Center, Winston-Salem, USA
10Department of Clinical and Experimental Medicine, Internal and Hepatology Unit, University of Messina, Messina, Italy
11Department of Cardiology, Oslo University Hospital, Ullevål, Oslo, Norway
12Clinique Pasteur, ESH Hypertension Excellence Center, Toulouse, France
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.