A new white paper by the European Liver Patient Association – ELPA highlights why it is time to bring liver health into the cardiovascular conversation. It shows that MASLD is far more than a liver condition—it magnifies heart risk across Europe.
MASLD: A silent but widespread condition
MASLD is defined by excess liver fat (≥5%) in combination with at least one cardiometabolic condition, such as obesity, type 2 diabetes, hypertension, or dyslipidemia. It affects 25–30% of European adults—a hidden epidemic. Prevalence is even higher in people with obesity (over 90%) and in those with type 2 diabetes (over 70%).
Despite these figures, MASLD often goes undetected because it progresses silently, without apparent symptoms, until advanced stages, including liver cancer. Scientific evidence shows that MASLD is not just a bystander, but an active driver of cardiovascular risk. The clinical impact is striking: people with MASLD and type 2 diabetes face a four-fold higher risk of cardiovascular events compared to those with diabetes alone. Cardiovascular complications are, in fact, the leading cause of death in MASLD patients. This multimorbidity creates a vicious cycle of poor outcomes, rising healthcare costs, and fragmented care.
The white paper stresses a crucial point: the liver reveals cardiovascular risk before the heart does. Non-invasive liver tests can identify people at high risk years before their first heart event. Risk calculators currently used in Europe, such as SCORE-2, do not include MASLD. As a result, patients are misclassified, and opportunities for early prevention are missed. A case study in the white paper illustrates this: a patient classified as “moderate risk” by current tools was reclassified as “high risk” once MASLD and fibrosis were detected, warranting more accurate treatment and care.
For too long, we have overlooked the liver's crucial role in the health of our people, and the cost of this inaction—measured in both lives and billions of euros—is staggering. The evidence presented by ELPA is undeniable
Delays in diagnosing MASLD also carry a heavy economic burden. Across Europe, MASLD-related costs are estimated at more than €35 billion in direct costs and a further €200 billion in societal costs annually, much of it due to late-stage liver disease and cardiovascular complications that could have been prevented.
Why screening is essential
Despite the strong evidence linking MASLD to cardiovascular disease, liver health is not included in European cardiovascular guidelines. This gap results in:
Routine metabolic check-ups already include simple blood tests that can be used to calculate non-invasive fibrosis scores, such as FIB-4. These tools, combined with imaging technology, allow cost-effective screening in primary care. The white paper emphasises that liver health screening should be integrated into existing cardiovascular and diabetes prevention programs. This would allow earlier detection, targeted lifestyle interventions, and more intensive management of patients at the highest risk.
The paper calls on the European Commission and Member States to formally recognise MASLD as a cardiometabolic risk factor, integrate liver health into EU cardiovascular strategies, and promote awareness among clinicians and citizens:
“For too long, we have overlooked the liver's crucial role in the health of our people, and the cost of this inaction—measured in both lives and billions of euros—is staggering. The evidence presented by ELPA is undeniable,” MEP Irena Joveva (Renew Europe, Slovenia) said in a statement. “Ignoring the link between MASLD and cardiovascular disease is no longer an option. It is time for the European Commission and Member States to act decisively, recognise MASLD as a major risk factor, and equip our primary care providers with the screening tools needed to turn the tide on Europe's leading killer,” she added, emphasising the importance of prevention and early detection.
In this context, ELPA’s European Liver Screening Week is a vital advocacy initiative. Every year, it is organised in Brussels in front of the European Parliament and under its Patronage. Screening hundreds of people, the event highlights the need for widespread, routine use of non-invasive liver testing across Europe, raising awareness among policymakers, healthcare providers, and the public about the importance of early detection and prevention.
Cardiovascular disease prevention strategies must include routine metabolic check-ups, early diagnosis intervention, and treatment of MASLD. We need to tackle the root causes of cardiovascular disease, not only the consequences
In addition, ELPA is proud to be part of 20 EU Horizon projects, connecting more than 250 partners and mobilizing nearly €200 million in European investment for liver and related health challenges. One of them, the LiverScreen project (H2020, Grant No. 847989) screened over 30,000 citizens in eight countries, showing that many seemingly healthy people already live with advanced, asymptomatic liver disease, particularly those with obesity, diabetes, or high alcohol use.
Building on an earlier EIT Health pilot with 3,600 citizens, LiverScreen confirmed that population-based screening is feasible, cost-effective, and lifesaving. Thanks to the European Commission’s support, this study provides the most substantial evidence that early detection prevents cirrhosis, cancer, and cardiovascular complications, while reducing long-term healthcare costs.
A high-level European discussion
These issues will not remain on paper. On December 4, policymakers, clinicians, researchers, and patient organisations will gather in Brussels for a high-level event to discuss MASLD, liver cancer, and the future of liver health screening in Europe.
A call to action
"Cardiovascular disease prevention strategies must include routine metabolic check-ups, early diagnosis intervention, and treatment of MASLD. We need to tackle the root causes of cardiovascular disease, not only the consequences," said MEP Sirpa Pietikäinen (EPP, Finland), one of many MEPs, including MEP Joveva, endorsing the ELPA white paper.
Cardiovascular disease continues to take lives prematurely across Europe. The evidence is clear: ignoring MASLD means overlooking a significant piece of the cardiovascular puzzle. By incorporating liver health screening into cardiovascular prevention strategies, Europe has the chance to protect millions, reduce healthcare costs, and save lives.
This article is a joint contribution from ELPA's Marko Korenjak, President, and Beatrice Credi, Head of Office
The European Liver Patient Association (ELPA) is a member-based, non-profit organisation dedicated to promoting the interests of people affected by liver disease across Europe. ELPA represents liver patients regardless of their origin, lifestyle, or type of liver condition. Through advocacy, education, and collaboration with healthcare professionals, researchers, and policymakers, ELPA works to ensure that patient engagement is meaningful and patients’ voices are central to healthcare decisions. Scan to read the white paper.
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