Henson JB, et al. - Given that non-alcoholic fatty liver disease (NAFLD) is correlated with an increased risk of cardiovascular disease, however, which individuals with NAFLD are at highest risk for cardiovascular disease is not well understood, researchers determined the factors related to incident cardiovascular events in a prospective cohort of people with biopsy-proven NAFLD without preexisting cardiovascular disease. Data reported that 26/285 people experienced an incident cardiovascular event after a median follow-up time of 5.2 years. The authors discovered that advanced fibrosis (stage 3-4) on biopsy and higher NAFLD fibrosis score were important and independent predictors of incident cardiovascular disease in adults with biopsy-proven NAFLD, even after considering traditional risk factors and cardiovascular risk scores. Such results should be considered when evaluating patients with NAFLD for primary cardiovascular disease prevention, and further research on the relationship between advanced fibrosis and cardiovascular disease is required.