{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,4]],"date-time":"2026-08-04T00:44:33Z","timestamp":1785804273889,"version":"3.56.0"},"reference-count":97,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2023,3,23]],"date-time":"2023-03-23T00:00:00Z","timestamp":1679529600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Life"],"abstract":"<jats:p>Over the past 100 years, cardiovascular disease (CVD) has become a leading cause of mortality and morbidity in developed countries, and similar trends have occurred for chronic liver disease. Subsequent research also indicated that people with non-alcoholic fatty liver disease (NAFLD) had a twofold increased risk of CV events and that this risk was doubled in those with liver fibrosis. However, no validated CVD risk score specific for NAFLD patients has yet been validated, as traditional risk scores tend to underestimate the CV risk in NAFLD patients. From a practical perspective, identifying NAFLD patients and assessing severity of liver fibrosis when concurrent atherosclerotic risk factors are already established may serve as an important criterion in new CV risk scores. The current review aims to assess current risk scores and their utility for the prediction of CV events among patients with NAFLD.<\/jats:p>","DOI":"10.3390\/life13040857","type":"journal-article","created":{"date-parts":[[2023,3,23]],"date-time":"2023-03-23T03:07:57Z","timestamp":1679540877000},"page":"857","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["Risk Scores for Prediction of Major Cardiovascular Events in Non-Alcoholic Fatty Liver Disease: A No Man\u2019s Land?"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8770-9340","authenticated-orcid":false,"given":"Liliana","family":"Gheorghe","sequence":"first","affiliation":[{"name":"Department of Radiology, \u201cGrigore T. Popa\u201d University of Medicine and Pharmacy, 700115 Iasi, Romania"},{"name":"Radiology Clinic, \u201cSt. Spiridon\u201d County Clinical Emergency Hospital, 700111 Iasi, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roxana","family":"Nemteanu","sequence":"additional","affiliation":[{"name":"Medical I Department, \u201cGrigore T. Popa\u201d University of Medicine and Pharmacy, 700115 Iasi, Romania"},{"name":"Institute of Gastroenterology and Hepatology, Saint Spiridon Hospital, 700111 Iasi, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andreea","family":"Clim","sequence":"additional","affiliation":[{"name":"Medical I Department, \u201cGrigore T. Popa\u201d University of Medicine and Pharmacy, 700115 Iasi, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gina Eosefina","family":"Botnariu","sequence":"additional","affiliation":[{"name":"Diabetes, Nutrition and Metabolic Diseases Department, University of Medicine and Pharmacy \u201cGr. T. Popa\u201d, 700115 Iasi, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Irina Iuliana","family":"Costache","sequence":"additional","affiliation":[{"name":"Medical I Department, \u201cGrigore T. Popa\u201d University of Medicine and Pharmacy, 700115 Iasi, Romania"},{"name":"Cardiology Clinic, \u201cSt. Spiridon\u201d County Clinical Emergency Hospital, 700111 Iasi, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alina","family":"Plesa","sequence":"additional","affiliation":[{"name":"Medical I Department, \u201cGrigore T. Popa\u201d University of Medicine and Pharmacy, 700115 Iasi, Romania"},{"name":"Institute of Gastroenterology and Hepatology, Saint Spiridon Hospital, 700111 Iasi, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,3,23]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"7","DOI":"10.12740\/PP\/103876","article-title":"ICD-11 vs. ICD-10\u2014A review of updates and novelties introduced in the latest version of the WHO International Classification of Diseases","volume":"54","author":"Krawczyk","year":"2020","journal-title":"Psychiatr. Pol."},{"key":"ref_2","unstructured":"(2022). WHO Guideline: Integrated Management of Adolescents in All Their Diversity with Obesity, World Health Organization."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"155217","DOI":"10.1016\/j.metabol.2022.155217","article-title":"A 2022 update on the epidemiology of obesity and a call to action: As its twin COVID-19 pandemic appears to be receding, the obesity and dysmetabolism pandemic continues to rage on","volume":"133","author":"Boutari","year":"2022","journal-title":"Metabolism"},{"key":"ref_4","unstructured":"(2023, February 15). Available online: https:\/\/www.worldobesity.org\/about\/about-obesity\/prevalence-of-obesity."},{"key":"ref_5","unstructured":"(2023, February 15). Available online: https:\/\/www.idf.org\/news\/259:one-billion-people-globally-estimated-to-be-living-with-obesity-by-2030.html."},{"key":"ref_6","first-page":"176","article-title":"Obesity: Definition, comorbidities, causes, and burden","volume":"22","author":"Apovian","year":"2016","journal-title":"Am. J. Manag. Care"},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Sinn, D.H., Kang, D., Choi, S.C., Hong, Y.S., Zhao, D., Guallar, E., Park, Y., Cho, J., and Gwak, G.Y. (2022). Non-Alcoholic Fatty Liver Disease without Metabolic Associated Fatty Liver Disease and the Risk of Metabolic Syndrome. Clin. Gastroenterol. Hepatol.","DOI":"10.1016\/j.cgh.2022.09.014"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"851","DOI":"10.1016\/S2468-1253(22)00165-0","article-title":"The prevalence and incidence of NAFLD worldwide: A systematic review and meta-analysis","volume":"7","author":"Riazi","year":"2022","journal-title":"Lancet Gastroenterol. Hepatol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"2","DOI":"10.1016\/S2468-1253(22)00375-2","article-title":"NAFLD prevalence and severity in overweight and obese populations","volume":"8","author":"Francque","year":"2022","journal-title":"Lancet Gastroenterol. Hepatol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"154433","DOI":"10.1016\/j.metabol.2020.154433","article-title":"MAFLD and risk of CKD","volume":"115","author":"Sun","year":"2021","journal-title":"Metabolism"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"2138","DOI":"10.1016\/j.cgh.2020.12.022","article-title":"Metabolic Dysfunction-Associated Fatty Liver Disease and Incident Cardiovascular Disease Risk: A Nationwide Cohort Study","volume":"19","author":"Lee","year":"2021","journal-title":"Clin. Gastroenterol. Hepatol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1284","DOI":"10.1016\/j.jhep.2021.07.035","article-title":"Metabolic dysfunction-associated fatty liver disease is associated with increased all-cause mortality in the United States","volume":"75","author":"Kim","year":"2021","journal-title":"J. Hepatol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"123","DOI":"10.1002\/hep.29466","article-title":"Modeling the epidemic of nonalcoholic fatty liver disease demonstrates an exponential increase in burden of disease","volume":"67","author":"Estes","year":"2018","journal-title":"Hepatology"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1736","DOI":"10.1016\/S0140-6736(18)32203-7","article-title":"Global, regional, and national age-sex-specific mortality for 282 causes of death in 195 countries and territories, 1980\u20132017: A systematic analysis for the Global Burden of Disease Study","volume":"392","author":"Roth","year":"2017","journal-title":"Lancet"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"774079","DOI":"10.3389\/fmed.2021.774079","article-title":"MAFLD\/NAFLD Biopsy-Free Scoring Systems for Hepatic Steatosis, NASH, and Fibrosis Diagnosis","volume":"8","year":"2022","journal-title":"Front. Med."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"47","DOI":"10.1016\/j.jhep.2014.12.012","article-title":"NAFLD: A multisystem disease","volume":"62","author":"Byrne","year":"2015","journal-title":"J. Hepatol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"2650","DOI":"10.1016\/j.cgh.2019.07.060","article-title":"Contemporary Epidemiology of Chronic Liver Disease and Cirrhosis","volume":"18","author":"Moon","year":"2020","journal-title":"Clin. Gastroenterol. Hepatol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"728","DOI":"10.1111\/apt.15660","article-title":"Advanced fibrosis is associated with incident cardiovascular disease in patients with non-alcoholic fatty liver disease","volume":"51","author":"Henson","year":"2020","journal-title":"Aliment. Pharmacol. Ther."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"8463640","DOI":"10.1155\/2022\/8463640","article-title":"Bidirectional Association between Hypertension and NAFLD: A Systematic Review and Meta-Analysis of Observational Studies","volume":"2022","author":"Li","year":"2022","journal-title":"Int. J. Endocrinol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1726","DOI":"10.1002\/hep.29546","article-title":"Nonalcoholic fatty liver disease incidence and impact on metabolic burden and death: A 20 year-community study","volume":"67","author":"Allen","year":"2018","journal-title":"Hepatology"},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Tana, C., Ballestri, S., Ricci, F., Di Vincenzo, A., Ticinesi, A., Gallina, S., Giamberardino, M.A., Cipollone, F., Sutton, R., and Vettor, R. (2019). Cardiovascular Risk in Non-Alcoholic Fatty Liver Disease: Mechanisms and Therapeutic Implications. Int. J. Environ. Res. Public Health, 16.","DOI":"10.3390\/ijerph16173104"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"419","DOI":"10.3390\/jcdd9120419","article-title":"Comprehensive Review of Cardiovascular Disease Risk in Nonalcoholic Fatty Liver Disease","volume":"9","author":"Josloff","year":"2022","journal-title":"J. Cardiovasc. Dev. Dis."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1547","DOI":"10.1002\/hep.27368","article-title":"Fibrosis stage is the strongest predictor for disease-specific mortality in NAFLD after up to 33 years of follow-up","volume":"61","author":"Ekstedt","year":"2015","journal-title":"Hepatology"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"467","DOI":"10.3390\/jcm10030467","article-title":"NAFLD and Cardiovascular Diseases: Epidemiological, Mechanistic and Therapeutic Considerations","volume":"10","author":"Niederseer","year":"2021","journal-title":"J. Clin. Med."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"290","DOI":"10.5009\/gnl210084","article-title":"Cardiovascular Risk Is Elevated in Lean Subjects with Nonalcoholic Fatty Liver Disease","volume":"16","author":"Kim","year":"2022","journal-title":"Gut Liver"},{"key":"ref_26","first-page":"e25495","article-title":"Nonalcoholic Fatty Liver Disease: An Emerging Modern-Day Risk Factor for Cardiovascular Disease","volume":"14","author":"Hassen","year":"2022","journal-title":"Cureus"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"3313","DOI":"10.1007\/s00018-018-2860-6","article-title":"Molecular mechanisms of hepatic lipid accumulation in non-alcoholic fatty liver disease","volume":"75","author":"Ipsen","year":"2018","journal-title":"Cell Mol. Life Sci."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"921","DOI":"10.1007\/s00392-020-01709-7","article-title":"NAFLD and cardiovascular diseases: A clinical review","volume":"110","author":"Kasper","year":"2021","journal-title":"Clin. Res. Cardiol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"2360","DOI":"10.1016\/j.jacc.2018.03.509","article-title":"Epicardial adipose tissue may mediate deleterious efects of obesity and infammation on the myocardium","volume":"71","author":"Packer","year":"2018","journal-title":"Cardiol. J. Am. Coll."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"1296","DOI":"10.1007\/s12272-016-0766-0","article-title":"In vitro and in vivo evaluation of the mechanisms of citalopram-induced hepatotoxicity","volume":"40","author":"Ahmadian","year":"2017","journal-title":"Arch. Pharm. Res."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"217","DOI":"10.1055\/s-0042-123034","article-title":"Mechanistic Approach for Toxic Effects of Bupropion in Primary Rat Hepatocytes","volume":"67","author":"Ahmadian","year":"2017","journal-title":"Drug Res."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"470","DOI":"10.1055\/s-0042-110178","article-title":"Triazole rizatriptan Induces Liver Toxicity through Lysosomal\/Mitochondrial Dysfunction","volume":"66","author":"Fard","year":"2016","journal-title":"Drug Res."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"376909","DOI":"10.4061\/2011\/376909","article-title":"Adiponectin in cardiovascular inflammation and obesity","volume":"2011","author":"Aprahamian","year":"2011","journal-title":"Int. J. Inflamm."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"1021","DOI":"10.1161\/CIRCRESAHA.115.306565","article-title":"Cardiac Fibrosis: The Fibroblast Awakens","volume":"118","author":"Travers","year":"2016","journal-title":"Circ. Res."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"235","DOI":"10.1161\/CIRCRESAHA.110.223875","article-title":"Oxidation-specific epitopes are danger-associated molecular patterns recognized by pattern recognition receptors of innate immunity","volume":"108","author":"Miller","year":"2011","journal-title":"Circ. Res."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"7143","DOI":"10.2147\/JIR.S344730","article-title":"Spotlight on NLRP3 Inflammasome: Role in Pathogenesis and Therapies of Atherosclerosis","volume":"14","author":"Jiang","year":"2021","journal-title":"J. Inflamm. Res."},{"key":"ref_37","doi-asserted-by":"crossref","unstructured":"Kaura, A., Hartley, A., Panoulas, V., Glampson, B., Shah, A.S.V., Davies, J., Mulla, A., Woods, K., Omigie, J., and Shah, A.D. (2022). Mortality risk prediction of high-sensitivity C-reactive protein in suspected acute coronary syndrome: A cohort study. PLoS Med., 19.","DOI":"10.1371\/journal.pmed.1003911"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"390","DOI":"10.4103\/jfmpc.jfmpc_887_19","article-title":"Association of high-sensitivity C-reactive protein (hs-CRP) with non-alcoholic fatty liver disease (NAFLD) in Asian Indians: A cross-sectional study","volume":"9","author":"Kumar","year":"2020","journal-title":"J. Fam. Med. Prim. Care"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"488","DOI":"10.1055\/s-0035-1550433","article-title":"Vascular Disease in Patients with Nonalcoholic Fatty Liver Disease","volume":"41","author":"Potze","year":"2015","journal-title":"Semin. Thromb. Hemost."},{"key":"ref_40","doi-asserted-by":"crossref","unstructured":"Juanola, O., Mart\u00ednez-L\u00f3pez, S., Franc\u00e9s, R., and G\u00f3mez-Hurtado, I. (2021). Non-Alcoholic Fatty Liver Disease: Metabolic, Genetic, Epigenetic and Environmental Risk Factors. Int. J. Environ. Res. Public Health, 18.","DOI":"10.3390\/ijerph18105227"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"1727","DOI":"10.1210\/js.2019-00065","article-title":"Hyperinsulinemia: An Early Indicator of Metabolic Dysfunction","volume":"3","author":"Thomas","year":"2019","journal-title":"J. Endocr. Soc."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"3175","DOI":"10.1093\/eurheartj\/eht351","article-title":"Endothelial dysfunction over the course of coronary artery disease","volume":"34","author":"Flammer","year":"2013","journal-title":"Eur. Heart J."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"14834","DOI":"10.1038\/s41598-021-94277-3","article-title":"AST to Platelet Ratio Index (APRI) is an easy-to-use predictor score for cardiovascular risk in metabolic subjects","volume":"11","author":"Cariello","year":"2021","journal-title":"Sci. Rep."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"229","DOI":"10.4065\/84.3.229","article-title":"Carotid intima-media thickness and coronary artery calcium score as indications of subclinical atherosclerosis","volume":"84","author":"Lester","year":"2009","journal-title":"Mayo Clin. Proc."},{"key":"ref_45","doi-asserted-by":"crossref","unstructured":"Nasiri-Ansari, N., Androutsakos, T., Flessa, C.M., Kyrou, I., Siasos, G., Randeva, H.S., Kassi, E., and Papavassiliou, A.G. (2022). Endothelial Cell Dysfunction and Nonalcoholic Fatty Liver Disease (NAFLD): A Concise Review. Cells, 11.","DOI":"10.3390\/cells11162511"},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"873","DOI":"10.1002\/hep4.1199","article-title":"Association of hepatic steatosis with subclinical atherosclerosis: Systematic review and meta-analysis","volume":"2","author":"Kapuria","year":"2018","journal-title":"Hepatol. Commun."},{"key":"ref_47","doi-asserted-by":"crossref","unstructured":"Higashi, Y. (2022). Roles of Oxidative Stress and Inflammation in Vascular Endothelial Dysfunction-Related Disease. Antioxidants, 11.","DOI":"10.3390\/antiox11101958"},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"600","DOI":"10.3389\/fphys.2017.00600","article-title":"Oxidative Stress-Mediated Atherosclerosis: Mechanisms and Therapies","volume":"23","author":"Yang","year":"2017","journal-title":"Front. Physiol."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"987","DOI":"10.1002\/hep.20920","article-title":"Insulin resistance: A metabolic pathway to chronic liver disease","volume":"42","author":"Bugianesi","year":"2005","journal-title":"Hepatology"},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"1720","DOI":"10.1194\/jlr.R087510","article-title":"Muscle and adipose tissue insulin resistance: Malady without mechanism?","volume":"60","author":"Fazakerley","year":"2019","journal-title":"J. Lipid Res."},{"key":"ref_51","doi-asserted-by":"crossref","unstructured":"Song, Z., Xiaoli, A.M., and Yang, F. (2018). Regulation and Metabolic Significance of De Novo Lipogenesis in Adipose Tissues. Nutrients, 10.","DOI":"10.3390\/nu10101383"},{"key":"ref_52","first-page":"1","article-title":"Triglyceride Metabolism in the Liver","volume":"8","author":"Cohen","year":"2017","journal-title":"Compr. Physiol."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1007\/s11010-021-04260-9","article-title":"Modulation of endothelium function by fatty acids","volume":"477","author":"Mallick","year":"2022","journal-title":"Mol. Cell. Biochem."},{"key":"ref_54","doi-asserted-by":"crossref","unstructured":"Calzadilla Bertot, L., and Adams, L. (2016). The natural course of non-alcoholic fatty liver disease. Int. J. Mol. Sci., 17.","DOI":"10.3390\/ijms17050774"},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"1865","DOI":"10.1053\/j.gastro.2020.01.053","article-title":"Toward Genetic Prediction of Nonalcoholic Fatty Liver Disease Trajectories: PNPLA3 and Beyond","volume":"158","author":"Krawczyk","year":"2020","journal-title":"Gastroenterology"},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1007\/s11892-021-01383-7","article-title":"The Relationship between Type 2 Diabetes, NAFLD, and Cardiovascular Risk","volume":"21","author":"Caussy","year":"2021","journal-title":"Curr. Diab. Rep."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"110","DOI":"10.4330\/wjc.v12.i4.110","article-title":"Role of gut microbiota in cardiovascular diseases","volume":"12","author":"Novakovic","year":"2020","journal-title":"World J. Cardiol."},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"1784","DOI":"10.1038\/s41467-017-01973-8","article-title":"Meta-analysis of gut microbiome studies identifies disease-specific and shared responses","volume":"8","author":"Duvallet","year":"2017","journal-title":"Nat. Commun."},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"101215","DOI":"10.1016\/j.diabet.2020.101215","article-title":"NAFLD, and cardiovascular and cardiac diseases: Factors influencing risk, prediction and treatment","volume":"47","author":"Targher","year":"2021","journal-title":"Diabetes Metab."},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"382","DOI":"10.4093\/dmj.2020.0010","article-title":"Non-Alcoholic Fatty Liver Disease in Patients with Type 2 Diabetes Mellitus: A Position Statement of the Fatty Liver Research Group of the Korean Diabetes Association","volume":"44","author":"Lee","year":"2020","journal-title":"Diabetes Metab. J."},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"e8179","DOI":"10.1097\/MD.0000000000008179","article-title":"Prevalence of nonalcoholic fatty liver disease in patients with type 2 diabetes mellitus: A meta-analysis","volume":"96","author":"Dai","year":"2017","journal-title":"Medicine"},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"60","DOI":"10.1186\/s13098-020-00570-y","article-title":"NAFLD as a continuum: From obesity to metabolic syndrome and diabetes","volume":"12","author":"Valerio","year":"2020","journal-title":"Diabetol. Metab. Syndr."},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"389","DOI":"10.1053\/j.gastro.2015.04.043","article-title":"Liver fibrosis, but no other histologic features, is associated with long-term outcomes of patients with nonalcoholic fatty liver disease","volume":"149","author":"Angulo","year":"2015","journal-title":"Gastroenterology"},{"key":"ref_64","doi-asserted-by":"crossref","unstructured":"Mantovani, A., Dalbeni, A., Beatrice, G., Cappelli, D., and Gomez-Peralta, F. (2022). Non-Alcoholic Fatty Liver Disease and Risk of Macro- and Microvascular Complications in Patients with Type 2 Diabetes. J. Clin. Med., 11.","DOI":"10.3390\/jcm11040968"},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"33386","DOI":"10.1038\/srep33386","article-title":"Association of non-alcoholic fatty liver disease with major adverse cardiovascular events: A systematic review and meta-analysis","volume":"6","author":"Wu","year":"2016","journal-title":"Sci. Rep."},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"376","DOI":"10.1002\/hep4.1155","article-title":"Nonalcoholic fatty liver disease contributes to subclinical atherosclerosis: A systematic review and meta-analysis","volume":"2","author":"Zhou","year":"2018","journal-title":"Hepatol. Commun."},{"key":"ref_67","doi-asserted-by":"crossref","first-page":"631","DOI":"10.1097\/MEG.0000000000001075","article-title":"Synergistic increase in cardiovascular risk in diabetes mellitus with nonalcoholic fatty liver disease: A meta-analysis","volume":"30","author":"Zhou","year":"2018","journal-title":"Eur. J. Gastroenterol. Hepatol."},{"key":"ref_68","first-page":"e30225","article-title":"Role of High-Sensitivity C-reactive Protein (Hs-CRP) in Non-communicable Diseases: A Review","volume":"14","author":"Banait","year":"2022","journal-title":"Cureus"},{"key":"ref_69","doi-asserted-by":"crossref","first-page":"1012887","DOI":"10.3389\/fphys.2022.1012887","article-title":"Serum high-sensitive C-reactive protein is a simple indicator for all-cause among individuals with MAFLD","volume":"13","author":"Huang","year":"2022","journal-title":"Front. Physiol."},{"key":"ref_70","doi-asserted-by":"crossref","first-page":"1999","DOI":"10.1053\/j.gastro.2019.11.312","article-title":"MAFLD: A Consensus-Driven Proposed Nomenclature for Metabolic Associated Fatty Liver Disease","volume":"158","author":"Eslam","year":"2020","journal-title":"Gastroenterology"},{"key":"ref_71","doi-asserted-by":"crossref","first-page":"5495","DOI":"10.4103\/jfmpc.jfmpc_2223_21","article-title":"Association between high-sensitivity-CRP and liver elastography and cardiac ischemic diseases in patients with fatty liver","volume":"11","author":"Nayebi","year":"2022","journal-title":"J. Fam. Med. Prim. Care"},{"key":"ref_72","doi-asserted-by":"crossref","first-page":"1207","DOI":"10.1097\/HJH.0000000000000532","article-title":"Blood pressure is associated with the presence and severity of nonalcoholic fatty liver disease across the spectrum of cardiometabolic risk","volume":"33","author":"Aneni","year":"2015","journal-title":"J. Hypertens."},{"key":"ref_73","doi-asserted-by":"crossref","first-page":"2015","DOI":"10.1097\/HJH.0b013e3283576faf","article-title":"High ambulatory blood pressure values associated with non-alcoholic fatty liver in middle-aged adults","volume":"30","author":"Vasunta","year":"2012","journal-title":"J. Hypertens."},{"key":"ref_74","doi-asserted-by":"crossref","first-page":"15938","DOI":"10.1038\/s41598-021-95581-8","article-title":"Liver fibrosis is associated with carotid atherosclerosis in patients with liver biopsy-proven nonalcoholic fatty liver disease","volume":"11","author":"Arai","year":"2021","journal-title":"Sci. Rep."},{"key":"ref_75","doi-asserted-by":"crossref","first-page":"176","DOI":"10.1111\/j.1478-3231.2010.02375.x","article-title":"Increased coagulation factor VIII, IX, XI and XII activities in non-alcoholic fatty liver disease","volume":"31","author":"Kotronen","year":"2011","journal-title":"Liver Int."},{"key":"ref_76","first-page":"209","article-title":"Serum levels of vascular endothelial growth factor in non-alcoholic fatty liver disease","volume":"30","author":"Papageorgiou","year":"2017","journal-title":"Ann. Gastroenterol."},{"key":"ref_77","doi-asserted-by":"crossref","first-page":"483","DOI":"10.3350\/cmh.2021.0406","article-title":"Non-alcoholic fatty liver disease increases risk of carotid atherosclerosis and ischemic stroke: An updated meta-analysis with 135,602 individuals","volume":"28","author":"Tang","year":"2022","journal-title":"Clin. Mol. Hepatol."},{"key":"ref_78","doi-asserted-by":"crossref","first-page":"413","DOI":"10.1007\/s12072-021-10167-w","article-title":"Liver fibrosis scores and coronary atherosclerosis: Novel findings in patients with stable coronary artery disease","volume":"15","author":"Jin","year":"2021","journal-title":"Hepatol. Int."},{"key":"ref_79","doi-asserted-by":"crossref","first-page":"1747","DOI":"10.1161\/CIRCRESAHA.121.319059","article-title":"Nonalcoholic Fatty Liver Disease: An Emerging Driver of Cardiac Arrhythmia","volume":"128","author":"Chen","year":"2021","journal-title":"Circ. Res."},{"key":"ref_80","doi-asserted-by":"crossref","first-page":"e001820","DOI":"10.1161\/JAHA.115.001820","article-title":"Nonalcoholic fatty liver disease is associated with QT prolongation in the general population","volume":"4","author":"Hung","year":"2015","journal-title":"J. Am. Heart Assoc."},{"key":"ref_81","doi-asserted-by":"crossref","first-page":"663","DOI":"10.1016\/j.numecd.2014.01.005","article-title":"Association of nonalcoholic fatty liver disease with QTc interval in patients with type 2 diabetes","volume":"24","author":"Targher","year":"2014","journal-title":"Nutr. Metab. Cardiovasc. Dis."},{"key":"ref_82","doi-asserted-by":"crossref","first-page":"10977","DOI":"10.1038\/s41598-022-14701-0","article-title":"Lean non-alcoholic fatty liver disease (Lean-NAFLD) and the development of metabolic syndrome: A retrospective study","volume":"12","author":"Wang","year":"2022","journal-title":"Sci. Rep."},{"key":"ref_83","doi-asserted-by":"crossref","unstructured":"Wijarnpreecha, K., Li, F., Lundin, S.K., Suresh, D., Song, M.W., Tao, C., Chen, V.L., and Lok, A.S.F. (2023). Higher mortality among lean patients with non-alcoholic fatty liver disease despite fewer metabolic comorbidities. Aliment. Pharmacol. Ther., ahead of print.","DOI":"10.1111\/apt.17424"},{"key":"ref_84","doi-asserted-by":"crossref","first-page":"1082","DOI":"10.1002\/hep.24452","article-title":"Diagnostic accuracy and reliability of ultrasonography for the detection of fatty liver: A meta-analysis","volume":"54","author":"Hernaez","year":"2011","journal-title":"Hepatology"},{"key":"ref_85","doi-asserted-by":"crossref","first-page":"615978","DOI":"10.3389\/fmed.2021.615978","article-title":"Liver Fibrosis in Non-alcoholic Fatty Liver Disease: From Liver Biopsy to Non-invasive Biomarkers in Diagnosis and Treatment","volume":"8","author":"Heyens","year":"2021","journal-title":"Front. Med."},{"key":"ref_86","doi-asserted-by":"crossref","first-page":"3061","DOI":"10.1111\/liv.14640","article-title":"Liver steatosis is highly prevalent and is associated with metabolic risk factors and liver fibrosis in adult patients with type 1 Gaucher disease","volume":"40","author":"Nascimbeni","year":"2020","journal-title":"Liver Int."},{"key":"ref_87","doi-asserted-by":"crossref","first-page":"181","DOI":"10.2147\/DMSO.S189544","article-title":"The fatty liver index, a simple and useful predictor of metabolic syndrome: Analysis of the Korea national health and nutrition examination survey 2010\u20132011","volume":"12","author":"Khang","year":"2019","journal-title":"Diabetes Metab. Syndr. Obes. Targets Ther."},{"key":"ref_88","doi-asserted-by":"crossref","first-page":"493","DOI":"10.1097\/HJH.0000000000001204","article-title":"Gamma-glutamyltransferase, fatty liver index and hepatic insulin resistance are associated with incident hypertension in two longitudinal studies","volume":"35","author":"Bonnet","year":"2017","journal-title":"J. Hypertens."},{"key":"ref_89","doi-asserted-by":"crossref","first-page":"245","DOI":"10.1186\/s12944-020-01419-z","article-title":"Association between the alanine aminotransferase\/aspartate aminotransferase ratio and new-onset nonalcoholic fatty liver disease in a nonobese Chinese population: A population-based longitudinal study","volume":"19","author":"Zou","year":"2020","journal-title":"Lipids Health Dis."},{"key":"ref_90","doi-asserted-by":"crossref","unstructured":"Schmitz, S.M.T., Kroh, A., Ulmer, T.F., Andruszkow, J., Luedde, T., Brozat, J.F., Neumann, U.P., and Alizai, P.H. (2020). Evaluation of NAFLD and fibrosis in obese patients\u2014A comparison of histological and clinical scoring systems. BMC Gastroenterol., 20.","DOI":"10.1186\/s12876-020-01400-1"},{"key":"ref_91","doi-asserted-by":"crossref","first-page":"98","DOI":"10.3390\/diagnostics11010098","article-title":"Liver Fibrosis Biomarkers Accurately Exclude Advanced Fibrosis and Are Associated with Higher Cardiovascular Risk Scores in Patients with NAFLD or Viral Chronic Liver Disease","volume":"11","author":"Ballestri","year":"2021","journal-title":"Diagnostics"},{"key":"ref_92","doi-asserted-by":"crossref","first-page":"595","DOI":"10.15562\/bmj.v10i2.2359","article-title":"Does nafld fibrosis score predict mortality risk among MAFLD patients?: A systematic review and meta-analysis","volume":"10","author":"Rahadini","year":"2021","journal-title":"Bali Med. J."},{"key":"ref_93","doi-asserted-by":"crossref","first-page":"261","DOI":"10.1111\/liv.14669","article-title":"Prognostic accuracy of FIB-4, NAFLD fibrosis score and APRI for NAFLD-related events: A systematic review","volume":"41","author":"Lee","year":"2021","journal-title":"Liver Int."},{"key":"ref_94","doi-asserted-by":"crossref","first-page":"484","DOI":"10.1038\/s41574-021-00507-z","article-title":"Emerging therapeutic approaches for the treatment of NAFLD and type 2 diabetes mellitus","volume":"17","author":"Ferguson","year":"2021","journal-title":"Nat. Rev. Endocrinol."},{"key":"ref_95","doi-asserted-by":"crossref","first-page":"399","DOI":"10.1016\/j.jhep.2015.08.038","article-title":"Glucagon-like peptide 1 decreases lipotoxicity in non-alcoholic steatohepatitis","volume":"64","author":"Armstrong","year":"2016","journal-title":"J. Hepatol."},{"key":"ref_96","doi-asserted-by":"crossref","first-page":"679","DOI":"10.1016\/S0140-6736(15)00803-X","article-title":"Liraglutide safety and efficacy in patients with non-alcoholic steatohepatitis (LEAN): A multicentre, double-blind, randomised, placebo-controlled phase 2 study","volume":"387","author":"Armstrong","year":"2016","journal-title":"Lancet"},{"key":"ref_97","doi-asserted-by":"crossref","first-page":"574","DOI":"10.1053\/j.gastro.2013.05.042","article-title":"Efficacy and safety of the farnesoid X receptor agonist obeticholic acid in patients with type 2 diabetes and nonalcoholic fatty liver disease","volume":"145","author":"Mudaliar","year":"2013","journal-title":"Gastroenterology"}],"container-title":["Life"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-1729\/13\/4\/857\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T19:01:13Z","timestamp":1760122873000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-1729\/13\/4\/857"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,3,23]]},"references-count":97,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2023,4]]}},"alternative-id":["life13040857"],"URL":"https:\/\/doi.org\/10.3390\/life13040857","relation":{},"ISSN":["2075-1729"],"issn-type":[{"value":"2075-1729","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,3,23]]}}}