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Multivariate Cox analyses evaluated the associations between TE parameters and the occurrence of cardiovascular events (CVEs) and mortality. TE parameters were assessed as continuous variables and dichotomized at low\/high values reflecting advanced liver fibrosis (LSM\u2009&gt;\u20099.6\u00a0kPa) and severe steatosis (CAP\u2009&gt;\u2009296 or &gt;\u2009330 dB\/m). Improvements in risk discrimination were assessed by C-statistic and by the relative Integrated Discrimination Improvement (IDI) index.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>During a median follow-up of 5.5 years, 85 patients died (40 from cardiovascular causes), and 69 had a CVE. As continuous variables, an increasing LSM was a risk marker for total CVEs (hazard ratio [HR]: 1.05; 95% CI: 1.01\u20131.08) and all-cause mortality (HR: 1.04; 95% CI: 1.01\u20131.07); whereas an increasing CAP was a protective factor for both outcomes (HR: 0.93; 95% CI: 0.89\u20130.98; and HR: 0.92; 95% CI: 0.88\u20130.97; respectively). As dichotomized variables, a high LSM remained a risk marker of adverse outcomes (with HRs ranging from 2.5 to 3.0) and a high CAP was protective (with HRs from 0.3 to 0.5). The subgroup of individuals with low-LSM\/high-CAP had the lowest risks while the opposite subgroup with high-LSM\/low-CAP had the highest risks. Both LSM and CAP improved risk discrimination, with increases in C-statistics up to 0.037 and IDIs up to 52%.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusions<\/jats:title>\n                <jats:p>Measured by hepatic TE, advanced liver fibrosis is a risk marker and severe steatosis is a protective factor for cardiovascular complications and mortality in individuals with type 2 diabetes and NAFLD.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s12933-021-01388-2","type":"journal-article","created":{"date-parts":[[2021,9,24]],"date-time":"2021-09-24T16:44:32Z","timestamp":1632501872000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":42,"title":["Prognostic impact of liver fibrosis and steatosis by transient elastography for cardiovascular and mortality outcomes in individuals with nonalcoholic fatty liver disease and type 2 diabetes: the Rio de Janeiro Cohort Study"],"prefix":"10.1186","volume":"20","author":[{"given":"Claudia R. 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