Evidence map›Paper›PMID 40909042›Full record

ReviewCureus2025

Evidence From a Systematic Review of Non-alcoholic Fatty Liver Disease (NAFLD)/Metabolic Dysfunction-Associated Fatty Liver Disease (MASLD) Fueling Cardiovascular Risk.

Nehal K Bhatt, Yashasvi Agarwal, Sanathanan Neelakantan Ramaswamy, Manvitha Bendagiri Matam, Samyuktha Harikrishnan, Shalvin Chand, Hetavi Bhatt, Iana Malasevskaia

Abstract readReview
In one paragraph

Review in Cureus, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 5 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
5citing papers in PubMed, 1 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

5 citing papers in PubMed, 1 synthesis or guideline pooled it.

  1. [Construction norms for the tiered diagnosis and treatment and standardized management center of metabolic-associated fatty liver disease].Zhonghua gan zang bing za zhi = Zhonghua ganzangbing zazhi = Chinese journal of hepatology · 2026
    Guideline
  2. Review
  3. Article
  4. Observational
  5. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

8 authors.

Nehal K BhattInternal Medicine, Pramukhswami Medical College, Karamsad, IND.
Yashasvi AgarwalInternal Medicine, Sir H.N. Reliance Foundation Hospital and Research Centre, Mumbai, IND.
Sanathanan Neelakantan RamaswamyInternal Medicine, Government Erode Medical College and Hospital, Erode, IND.
Manvitha Bendagiri MatamMedicine, Gandhi Medical College, Secunderabad, IND.
Samyuktha HarikrishnanMedicine, Gulf Medical University, Ajman, ARE.
Shalvin ChandMedicine, University of Fiji, Lautoka, FJI.
Hetavi BhattPharmacy, Parul University, Vadodara, IND.
Iana MalasevskaiaObstetrics and Gynecology, Private Clinic 'Yana Alexandr', Sana'a, YEM.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

Non-alcoholic fatty liver disease (NAFLD), now termed metabolic dysfunction-associated steatotic liver disease (MASLD), is increasingly implicated as a key risk factor for cardiovascular disease (CVD). However, its independent contribution remains debated due to confounding metabolic factors and methodological heterogeneity. This review aims to synthesize evidence on the association between NAFLD/MASLD and cardiovascular outcomes, focusing on the influence of liver fibrosis and metabolic dysfunction.  Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines, we searched PubMed/MEDLINE, ScienceDirect, Europe PMC, and Cochrane Library (through May 2025) for observational studies and trials assessing NAFLD/MASLD and CVD outcomes in adults. NAFLD required imaging/biopsy or validated scores (fatty liver index (FLI) ≥30, Fibrosis-4 Index (FIB-4)); comparators were non-NAFLD controls. Outcomes included myocardial infarction, stroke, CVD mortality, and atherosclerosis. Two reviewers independently screened records, extracted data, and assessed risk of bias (Newcastle-Ottawa Scale (NOS)/Cochrane RoB 2).  The systematic search identified 21 eligible studies (18 cohort, two cross-sectional, and one RCT). Sample sizes ranged widely, from a few hundred in clinical cohorts to over 9.5 million in a national database study. Observational studies demonstrated good methodological quality (mean NOS score ≥7/9). NAFLD/MASLD showed a consistent dose-dependent association with cardiovascular risk, with effect sizes ranging from modest (adjusted HR=1.2) to substantial (HR=8.0). Risk stratification revealed (i) advanced fibrosis (FIB-4 >2.67) quadrupled CVD risk (HR >4.5) and (ii) metabolic burden significantly amplified outcomes (HR=8.04 for ≥4 risk factors). While the association remained significant in most studies, rigorous adjustment for metabolic covariates attenuated effects in some analyses, suggesting that MASLD represents both an independent pathogenic factor and a metabolic dysfunction marker. NAFLD/MASLD is a significant risk factor for adverse cardiovascular outcomes, with the degree of risk strongly graded by the severity of liver fibrosis and metabolic comorbidity. While evidence is predominantly observational, these findings support integrating non-invasive fibrosis assessment into CVD risk stratification. Future research requires randomized trial testing whether MASLD-targeted therapies can reduce cardiovascular events.

Indexed as

cardiovascular diseasefibrosismetabolic dysfunction-associated steatotic liver diseasenon-alcoholic fatty liver diseasesystematic review

Identifiers

PMID40909042
PMCPMC12407576

What Socratic holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.