Metabolic dysfunction-associated steatotic liver disease (MASLD) is increasingly becoming one of the most prevalent chronic liver diseases worldwide. Although the disease directly impairs liver function, causing abnormal fat accumulation and hepatocellular injury, its most life-threatening threat often does not originate from liver lesions themselves. In fact, MASLD more commonly significantly elevates patients’ all-cause mortality risk by triggering a series of severe extrahepatic complications, including cardiovascular disease, metabolic syndrome, type 2 diabetes, and chronic kidney disease.
Approximately 38% of adults globally are affected by MASLD, which is closely linked to the epidemics of obesity and diabetes. MASLD is a major risk factor for major adverse cardiovascular events, the leading cause of death in this population, with a cardiac-specific mortality rate of 4.2 per 1,000 person-years, far higher than liver-related mortality. Sudden cardiac arrest (SCA), defined as the abrupt cessation of cardiac activity, often represents the terminal outcome of such events, highlighting the critical need for primary prevention and risk stratification. Notably, the prevalence of MASLD reaches 24.2% in high-risk cardiac cohorts and significantly increases the risk of ventricular arrhythmias and major cardiovascular events.
MASLD elevates cardiovascular risk through multiple pathways, including chronic inflammation, lipotoxicity, and metabolic dysregulation. It frequently coexists with insulin resistance, dyslipidemia, and hypertension, all of which synergistically exacerbate this risk. The insidious progression of MASLD and its cardiovascular complications makes early identification of high-risk individuals in primary care both essential and challenging.