Metabolic dysfunction-associated steatotic liver disease (MASLD) is the most prevalent chronic liver disorder globally and is increasingly recognized as a key contributor to cardiovascular disease (CVD). The association between MASLD and CVD extends beyond shared risk factors such as obesity, type 2 diabetes, and dyslipidemia, indicating direct pathogenic interactions along the liver-vascular axis. MASLD is linked to subclinical atherosclerosis, cardiac remodeling, arrhythmias, and major adverse cardiovascular events. However, although CVD is a leading cause of death in MASLD, its independent contribution to cardiovascular mortality after adjustment for traditional risk factors remains controversial. This review examines the underlying mechanisms connecting MASLD and vascular dysfunction, including visceral adiposity, chronic low-grade inflammation, oxidative stress, endothelial dysfunction, insulin resistance, and postprandial hyperlipidemia. Hepatokines, lipotoxicity, and gut-derived metabolites are emerging mediators of vascular injury. Given the global burden of MASLD, heightened awareness of its cardiovascular implications is essential. Early identification of high-risk individuals and targeted interventions may help reduce cardiovascular morbidity and mortality. Further research is needed to clarify causal pathways and support the development of diagnostic and therapeutic interventions focused on the liver-vascular interface.

Background: Vascular failure is strongly associated with heart diseases. Although heart diseases have long been the leading cause of death, its co-occurance with other diseases in the several years preceding death remains unknown. This observational study, patient hospital data to analyze the co-occurance of diseases within the 10 years preceding patients' death.

Methods: A total of 407 patients (239 males and 177 females) from 3 general hospitals in Japan were enrolled. The top 14 diseases with high prevalence in the last 10 years were extracted using International Classification of Diseases (ICD) -10 codes. The overlaps between each disease were statistically analyzed using multivariable logistic regression analysis and evaluated accuracy of results using Receiver Operating Characteristic (ROC) analysis.

Results: The diseases that rapidly increase in one year prior to death were heart failure, cancer, anemia, stroke, and pneumonia. Heart failure strongly overlapped with myocardial infarction and pneumonia, and moderately overlapped with renal failure and anemia. Interestingly, heart failure was more frequently associated with pneumonia and myocardial infarction 1 year prior to death, and cancer and anemia 3 years prior to death. In addition, sex analysis showed that pneumonia was more common in males, whereas myocardial infarction and anemia were more common in females in the 10 years prior to death.

Conclusion: Heart failure and pneumonia co-occur one year prior to death, which is associated with an increased risk of causing death.