Allen AM, Therneau TM, Mara KC, et al. - Researchers examined female gender as a protective factor against cardiovascular (CV) disease (myocardial infarction, angina, and stroke) in nonalcoholic fatty liver disease (NAFLD). For this work, they assessed 3,869 individuals with NAFLD and 15,209 age- and sex-matched referent individuals from Olmsted County, Minnesota. The development of 3,851 CV events was recorded after a median follow-up time of 7 (range 1–20) years. In the general population, female gender was identified as protective for ischemic CV events, however, among those with NAFLD, the impact was significantly decreased, even after stratification by time-dependent CV risk factors and control for diagnostic testing (liver enzymes and ultrasound) during routine medical evaluations, as a surrogate of access to care. This indicates that the CV protection conferred by the female sex is lost in women with NAFLD, and current estimating methods underestimate their risk in clinical practice.