Cardiovascular Disease in the Context of Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD): A Comprehensive Narrative Review

Mustafa, Attia; Kite, Chris; Lagojda, Lukasz; Dallaway, Alexander; Chatha, Kamaljit Kaur; Than, Nwe Ni; Kassi, Eva; Kyrou, Ioannis; Randeva, Harpal S.

doi:10.3390/ijms262311275

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Cardiovascular Disease in the Context of Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD): A Comprehensive Narrative Review

by

Attia Mustafa

^1,2,3,4,

Chris Kite

^1,5,6

,

Lukasz Lagojda

^1,7

,

Alexander Dallaway

^1,5

,

Kamaljit Kaur Chatha

^2,4,8,9,

Nwe Ni Than

¹⁰,

Eva Kassi

^11,12,

Ioannis Kyrou

^{1,2,4,13,14,15,*,†}

and

Harpal S. Randeva

^{1,2,4,15,*,†}

¹

Warwickshire Institute for the Study of Diabetes, Endocrinology and Metabolism (WISDEM), University Hospitals Coventry and Warwickshire NHS Trust, Coventry CV2 2DX, UK

²

Warwick Medical School, University of Warwick, Coventry CV4 7AL, UK

³

Internal Medicine Department, Faculty of Medicine, Omar Al Mukhtar University, Al-Bayda P.O. Box 919, Libya

⁴

Institute for Cardiometabolic Medicine, University Hospitals Coventry and Warwickshire NHS Trust, Coventry CV2 2DX, UK

⁵

School of Health and Wellbeing, Faculty of Education, Health and Wellbeing, University of Wolverhampton, Wolverhampton WV1 1LY, UK

⁶

Division of Public Health, Sport and Wellbeing, Faculty of Health, Medicine and Society, University of Chester, Chester, CH1 4BJ, UK

⁷

Centre for Health and Related Research (SCHARR), School of Medicine and Population Health, University of Sheffield, Sheffield S1 4DA, UK

⁸

Department of Biochemistry and Immunology, University Hospitals Coventry and Warwickshire NHS Trust, Coventry CV2 2DX, UK

⁹

Institute of Precision Diagnostics and Translational Medicine, University Hospitals Coventry and Warwickshire NHS Trust, Coventry CV2 2DX, UK

¹⁰

Gastroenterology and Hepatology Department, University Hospitals Coventry and Warwickshire NHS Trust, Coventry CV2 2DX, UK

¹¹

Department of Biological Chemistry, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece

¹²

Endocrine Unit, 1st Department of Propaupedic Internal Medicine, Laiko Hospital, National and Kapodistrian University of Athens, 11527 Athens, Greece

¹³

Aston Medical School, College of Health and Life Sciences, Aston University, Birmingham B4 7ET, UK

¹⁴

College of Health, Psychology and Social Care, University of Derby, Derby DE22 1GB, UK

¹⁵

Centre for Sport, Exercise and Life Sciences, Research Institute for Health & Wellbeing, Coventry University, Coventry CV1 5FB, UK

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^*

Authors to whom correspondence should be addressed.

^†

These authors contributed equally to this work.

Int. J. Mol. Sci. 2025, 26(23), 11275; https://doi.org/10.3390/ijms262311275

Submission received: 27 September 2025 / Revised: 17 November 2025 / Accepted: 18 November 2025 / Published: 21 November 2025

(This article belongs to the Special Issue Molecular Advances in Metabolic Dysfunction-Associated Steatotic Liver Disease)

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Abstract

Metabolic dysfunction-associated steatotic liver disease (MASLD) is a chronic hepatic disease with a rising global prevalence (25–38% of the general population). As a new term, MASLD was introduced in 2023 to replace the previous nomenclature of non-alcoholic fatty liver disease (NAFLD) and metabolic dysfunction-associated fatty liver disease (MAFLD). This new term/definition introduced changes in the diagnostic criteria and underscores the direct link between cardio-metabolic risk and this prevalent liver disease. In this context, the present review examines the clinical and pathophysiological links between MASLD and cardiovascular disease (CVD), providing a robust evidence synthesis of primarily systematic review data on the association between MASLD and coronary artery disease (CAD), atrial fibrillation (AF), and heart failure (HF). This association appears to be not only synergistic, but also independent of other known CVD risk factors, highlighting MASLD as a key cardio-metabolic risk factor that merits prompt diagnosis and treatment. The development of MASLD-related cardiovascular morbidity increases with the severity of the underlying hepatic pathology, particularly with progression to steatohepatitis and fibrosis. Notably, growing evidence highlights the links between MASLD and CVD through cardiac structural, electrical, and functional alterations that can progress to CAD, AF, and new-onset HF. Recognizing these links in clinical practice underscores the importance of early detection and multi-disciplinary management of MASLD to prevent disease progression and CVD complications.

Keywords: metabolic dysfunction-associated steatotic liver disease; MASLD; non-alcoholic fatty liver disease; NAFLD; metabolic dysfunction-associated fatty liver disease; MAFLD; cardiovascular disease; coronary artery disease; atrial fibrillation; heart failure

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MDPI and ACS Style

Mustafa, A.; Kite, C.; Lagojda, L.; Dallaway, A.; Chatha, K.K.; Than, N.N.; Kassi, E.; Kyrou, I.; Randeva, H.S. Cardiovascular Disease in the Context of Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD): A Comprehensive Narrative Review. Int. J. Mol. Sci. 2025, 26, 11275. https://doi.org/10.3390/ijms262311275

AMA Style

Mustafa A, Kite C, Lagojda L, Dallaway A, Chatha KK, Than NN, Kassi E, Kyrou I, Randeva HS. Cardiovascular Disease in the Context of Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD): A Comprehensive Narrative Review. International Journal of Molecular Sciences. 2025; 26(23):11275. https://doi.org/10.3390/ijms262311275

Chicago/Turabian Style

Mustafa, Attia, Chris Kite, Lukasz Lagojda, Alexander Dallaway, Kamaljit Kaur Chatha, Nwe Ni Than, Eva Kassi, Ioannis Kyrou, and Harpal S. Randeva. 2025. "Cardiovascular Disease in the Context of Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD): A Comprehensive Narrative Review" International Journal of Molecular Sciences 26, no. 23: 11275. https://doi.org/10.3390/ijms262311275

APA Style

Mustafa, A., Kite, C., Lagojda, L., Dallaway, A., Chatha, K. K., Than, N. N., Kassi, E., Kyrou, I., & Randeva, H. S. (2025). Cardiovascular Disease in the Context of Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD): A Comprehensive Narrative Review. International Journal of Molecular Sciences, 26(23), 11275. https://doi.org/10.3390/ijms262311275

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Cardiovascular Disease in the Context of Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD): A Comprehensive Narrative Review

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