Cardoso CRL, Villela-Nogueira CA, Leite NC, et al. - According to this longitudinal prospective study, advanced liver fibrosis, as measured by hepatic transient elastography (TE), is a risk marker for cardiovascular problems and mortality in people with type 2 diabetes and nonalcoholic fatty liver disease (NAFLD), although severe steatosis is a protective factor.

• At baseline, 400 type 2 diabetic patients with NAFLD received a TE examination (by Fibroscan).

• During a 5.5-year median follow-up, 85 individuals died (40 from cardiovascular causes) and 69 experienced a cardiovascular event (CVE).

• A rising liver stiffness measurement (LSM) was a risk factor for total CVEs and all-cause mortality as a continuous variable, whereas an increasing controlled attenuation parameter (CAP) was a protective factor for both outcomes.

• As dichotomized variables, a high LSM remained a risk factor for negative outcomes, whereas a high CAP was protective.

• Individuals with low-LSM/high-CAP had the lowest risks, whereas those with high-LSM/low-CAP had the highest.

• LSM and CAP both enhanced risk discrimination, with C-statistics increasing by up to 0.037 and Integrated Discrimination Improvements increasing by up to 52%.