0037Nonalcoholic Fatty Liver Disease Severity and Subclinical Cardiac Dysfunction in Prediabetes: A Systematic Review

Objective To systematically evaluate associations between nonalcoholic fatty liver disease (NAFLD) severity and early cardiovascular dysfunction in adults with prediabetes and early type 2 diabetes. Methods A systematic review was conducted according to PRISMA guidelines using PubMed, Embase, Scopus, and Web of Science through April 2026. Studies evaluating hepatic steatosis, liver fibrosis, metabolic dysfunction-associated fatty liver disease, cardiac structural abnormalities, endothelial dysfunction, or cardiovascular risk prediction in adults with prediabetes were included. Data regarding hepatic biomarkers, cardiovascular outcomes, predictive performance, and clinical implementation potential were extracted. Results Forty-five studies met inclusion criteria. Greater NAFLD severity was consistently associated with endothelial dysfunction, arterial stiffness, impaired diastolic function, coronary artery calcification, systemic inflammation, and increased progression of subclinical cardiovascular disease. Several studies demonstrated significant associations between hepatic fibrosis markers and cardiometabolic instability prior to overt cardiovascular disease diagnosis. Predictive performance was strongest in studies integrating hepatic imaging with multimodal cardiometabolic biomarkers. Major limitations included retrospective study designs, heterogeneous liver imaging methodologies, inconsistent external validation, and limited prospective cardiovascular outcome assessment. Few studies evaluated large-scale clinical implementation. Conclusions NAFLD severity demonstrates promising utility as an early biomarker of cardiovascular dysfunction in prediabetes. However, larger prospective studies and standardized validation frameworks remain necessary before widespread integration into preventative cardiometabolic care pathways. Is this an encore abstract? No