Non-alcoholic fatty liver disease (NAFLD) has become the most common chronic liver disease globally, affecting up to 38% of the adult population. It is a multisystem disease where systemic insulin resistance and metabolic dysfunction play a crucial role in the development of liver-related morbidities (cirrhosis, liver failure, and hepatocellular carcinoma) and extrahepatic complications such as cardiovascular disease (CVD), type 2 diabetes mellitus, chronic kidney disease, and certain types of extrahepatic cancers. In 2023, three multinational liver associations proposed replacing NAFLD with metabolic dysfunction-associated steatotic liver disease (MASLD) and non-alcoholic steatohepatitis with metabolic dysfunction-associated steatohepatitis (MASH). Emerging evidence suggests a high concordance rate between NAFLD and MASLD definitions, with ~99% of individuals with NAFLD meeting MASLD criteria. This narrative review provides an overview of the literature on recent epidemiological data on MASLD and its risk of CVD and malignant complications, underlying mechanisms, and diagnosis and assessment of CVD risk and potential treatments. MASLD is recognized as a significant risk factor for major adverse cardiovascular events, with substantial epidemiological evidence showing it as an independent risk factor for CVD morbidity and mortality. Meta-analyses and cohort studies consistently demonstrate that MASLD is associated with an increased risk of CVD outcomes, including all-cause, cardiac-specific, extrahepatic cancer-specific, and liver-specific mortality. Additionally, MASLD promotes accelerated coronary atherosclerosis and affects other heart structures, increasing the risk of left ventricular diastolic dysfunction, hypertrophy, cardiac valvular calcification, and arrhythmias. MASLD is also a risk factor for hepatocellular carcinoma (HCC) and other extrahepatic cancers, with higher incidence rates observed in individuals with MASLD compared to those without. The pathophysiology of MASLD involves chronic liver inflammation, low-grade systemic inflammation, metabolic dysfunction, and atherogenic dyslipidaemia. These factors contribute to liver fibrosis and further complications, as well as promoting CVD outcomes and cancer development. Anti-inflammatory therapies may play a crucial role in managing MASLD/MASH. For CVD risk assessment in MASLD, clinicians should consider both non-modifiable and modifiable risk factors, including age, sex, family history, ethnicity, smoking, plasma LDL-C concentration, physical activity, diet, and obesity. Lifestyle modifications and pharmacological treatments, such as statins, GLP-1 receptor agonists, and dual GLP-1/GIP receptor agonists, are recommended to reduce CVD risk. The review emphasizes the need for personalized treatment decisions based on individual risk factors and comorbidities.Non-alcoholic fatty liver disease (NAFLD) has become the most common chronic liver disease globally, affecting up to 38% of the adult population. It is a multisystem disease where systemic insulin resistance and metabolic dysfunction play a crucial role in the development of liver-related morbidities (cirrhosis, liver failure, and hepatocellular carcinoma) and extrahepatic complications such as cardiovascular disease (CVD), type 2 diabetes mellitus, chronic kidney disease, and certain types of extrahepatic cancers. In 2023, three multinational liver associations proposed replacing NAFLD with metabolic dysfunction-associated steatotic liver disease (MASLD) and non-alcoholic steatohepatitis with metabolic dysfunction-associated steatohepatitis (MASH). Emerging evidence suggests a high concordance rate between NAFLD and MASLD definitions, with ~99% of individuals with NAFLD meeting MASLD criteria. This narrative review provides an overview of the literature on recent epidemiological data on MASLD and its risk of CVD and malignant complications, underlying mechanisms, and diagnosis and assessment of CVD risk and potential treatments. MASLD is recognized as a significant risk factor for major adverse cardiovascular events, with substantial epidemiological evidence showing it as an independent risk factor for CVD morbidity and mortality. Meta-analyses and cohort studies consistently demonstrate that MASLD is associated with an increased risk of CVD outcomes, including all-cause, cardiac-specific, extrahepatic cancer-specific, and liver-specific mortality. Additionally, MASLD promotes accelerated coronary atherosclerosis and affects other heart structures, increasing the risk of left ventricular diastolic dysfunction, hypertrophy, cardiac valvular calcification, and arrhythmias. MASLD is also a risk factor for hepatocellular carcinoma (HCC) and other extrahepatic cancers, with higher incidence rates observed in individuals with MASLD compared to those without. The pathophysiology of MASLD involves chronic liver inflammation, low-grade systemic inflammation, metabolic dysfunction, and atherogenic dyslipidaemia. These factors contribute to liver fibrosis and further complications, as well as promoting CVD outcomes and cancer development. Anti-inflammatory therapies may play a crucial role in managing MASLD/MASH. For CVD risk assessment in MASLD, clinicians should consider both non-modifiable and modifiable risk factors, including age, sex, family history, ethnicity, smoking, plasma LDL-C concentration, physical activity, diet, and obesity. Lifestyle modifications and pharmacological treatments, such as statins, GLP-1 receptor agonists, and dual GLP-1/GIP receptor agonists, are recommended to reduce CVD risk. The review emphasizes the need for personalized treatment decisions based on individual risk factors and comorbidities.