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May 27, 2026Medicina0 citationsOpen Access

MASLD and Atherosclerosis in Type 2 Diabetes Patients: A Systematic Review

MASLD and Atherosclerosis in Patients with Type 2 Diabetes Mellitus: A Systematic Review

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Why the study?

The relationship between MASLD and subclinical or clinical atherosclerosis in patients with type 2 diabetes remains controversial, with inconsistent findings across imaging modalities and populations.

Does MASLD increase atherosclerosis in adults with Type 2 Diabetes?

Population

Adults with type 2 diabetes and MASLD/NAFLD across included studies

Comparison

Presence vs absence of MASLD/NAFLD or hepatic fibrosis vs steatosis alone

Design

Systematic review of predominantly cross-sectional and longitudinal studies

Key result

MASLD in patients with type 2 diabetes is associated with increased carotid plaque progression, with hepatic fibrosis acting as a stronger determinant of atherosclerosis than steatosis alone.

Authors

C(Cosmina-Theodora Vulpescu (Diaconu)DRDelia Reurean‐PintileiMCMarius-Costin Chitu

Discussion

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Overview

Evidence on MASLD-atherosclerosis link in T2D remains inconsistent across modalities; leaves open need for standardized prospective studies.

Key Points

  • This review aims to clarify the relationship between metabolic dysfunction-associated steatotic liver disease (MASLD) and atherosclerosis in patients with type 2 diabetes mellitus (T2D).
  • Conducted a systematic review following PRISMA guidelines, registered in PROSPERO CRD420261347480.
  • Searched PubMed, Scopus, and Web of Science databases for studies published from January 2016 to March 2026.
  • Included original full-text studies in English, focusing on atherosclerosis evaluation in adults with T2D and MASLD.
  • MASLD is linked with increased carotid plaque progression, even in lean individuals.
  • The relationship between MASLD and carotid intima-media thickness (CIMT) is inconsistent across studies.
  • Hepatic fibrosis shows a stronger connection to vascular aging compared to steatosis alone.

Study Design

Type

Systematic Review

Structured PICO

Does MASLD increase atherosclerosis in adults with Type 2 Diabetes?

P
Population
Adults with Type 2 Diabetes (T2D) and Metabolic dysfunction-associated steatotic liver disease (MASLD) or NAFLD
I
Intervention
Presence of MASLD/NAFLD and hepatic fibrosis
C
Comparator
Absence of MASLD/NAFLD or steatosis alone
O
Outcome
Atherosclerosis evaluation (subclinical/clinical, carotid plaque progression, carotid intima-media thickness, pulse wave velocity)surrogate

In patients with T2D, MASLD (particularly with liver fibrosis) is associated with more advanced stages of atherosclerosis such as plaque presence or progression, though associations with early subclinical markers remain inconsistent.

Limitations

  • Evidence base is limited and largely derived from a small number of predominantly cross-sectional studies
  • Heterogeneous findings across imaging modalities and study populations
  • limited evidence base
  • small number of predominantly cross-sectional studies
  • heterogeneous findings
  • variability due to differences in study methods and populations

Cite This Study

(Diaconu) et al. (2026) conducted a systematic review in Type 2 Diabetes Mellitus and MASLD. Metabolic dysfunction-associated steatotic liver disease (MASLD) was evaluated on Atherosclerosis (carotid plaque progression, CIMT, pulse wave velocity). MASLD in patients with type 2 diabetes is associated with increased carotid plaque progression, with hepatic fibrosis acting as a stronger determinant of atherosclerosis than steatosis alone.

synapsesocial.com/papers/6a168b280c924ddd1bd5a008https://doi.org/10.3390/medicina62050919
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