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This comprehensive prospective study involving over 318,000 participants reveals that subclinical liver disease—characterized by hepatic steatosis, fibrosis, and functional decline—is independently and synergistically linked to an increased risk of incident cardiovascular events. Non-invasive biomarkers, including the fatty liver index (FLI), fibrosis-4 index (FIB-4), and albumin-bilirubin (ALBI) score, provide valuable prognostic information beyond traditional cardiovascular risk factors. Notably, combined elevation of these biomarkers confers more than a twofold risk for cardiovascular disease (CVD), with sex-specific variations in risk profiling.
