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Cardiovascular disease is a common comorbidity in patients with MASLD and its prevalence is increasing in parallel. Recent evidence suggests that especially liver stiffness, whether or not existing against a background of MASLD, is associated with heart diseases. We conducted a narrative review on the role of liver stiffness in the prediction of highly prevalent heart diseases including heart failure, cardiac arrhythmias (in particular atrial fibrillation), coronary heart disease, and aortic valve sclerosis. Research papers were retrieved from major scientific databases (PubMed, Web of Science) until September 2023 using \u2018liver stiffness\u2019 and \u2018liver fibrosis\u2019 as keywords along with the latter cardiac conditions. Increased liver stiffness, determined by vibration\u2010controlled transient elastography or hepatic fibrosis as predicted by biomarker panels, are associated with a variety of cardiovascular diseases, including heart failure, atrial fibrillation, and coronary heart disease. Elevated liver stiffness in patients with metabolic liver disease should lead to considerations of cardiac workup including N\u2010terminal pro\u2013B\u2010type natriuretic peptide\/B\u2010type natriuretic peptide determination, electrocardiography, and coronary computed tomography angiography. In addition, patients with MASLD would benefit from heart disease case\u2010finding strategies in which liver stiffness measurements can play a key role. In conclusion, increased liver stiffness should be a trigger to consider a cardiac workup in metabolically compromised patients.<\/jats:p>","DOI":"10.1111\/liv.15801","type":"journal-article","created":{"date-parts":[[2023,11,28]],"date-time":"2023-11-28T14:08:51Z","timestamp":1701180531000},"page":"344-356","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":22,"title":["Liver stiffness as a cornerstone in heart disease risk assessment"],"prefix":"10.1111","volume":"44","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8399-5872","authenticated-orcid":false,"given":"Joost","family":"Boeckmans","sequence":"first","affiliation":[{"name":"Metabolic Liver Research Center, I. 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