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Background Metabolic dysfunction-associated steatotic liver disease (MASLD) is a well-established driver of cardiovascular disease (CVD). However, the subsequent risk of liver-related events (LREs) after CVD is often overlooked. We investigated whether incident CVD elevates long-term LRE risk in MASLD patients.Methods We used UK Biobank data to determine whether incident CVD (the exposure; coronary heart disease [CHD], myocardial infarction [MI], heart failure [HF], or atrial fibrillation [AF]) raises the risk of LREs (the outcome; including complications such as new-onset cirrhosis, liver failure or hepatocellular carcinoma) in MASLD patients. A semi-Markov multi-state model estimated transition rates, and time-dependent Cox regression models calculated adjusted hazard ratios (aHR) for LREs risk. Additionally, imaging and proteomic data were analyzed to explore biological mechanisms ( IDDF2026-ABS-0362 Figure 1).Results Among 142,454 MASLD patients, 22,630 (15.9%) developed incident CVD, and 2,635 (1.8%) progressed to LREs over a median of 15.1 years. The transition rates from CVD to LREs were higher than the direct progression from MASLD to LREs (3.56 vs. 1.08 per 1,000 person-years, IDDF2026-ABS-0362 Figure 2). The risk varied by CVD subtype, being highest for HF, followed by AF, CHD, and MI (IDDF2026-ABS-0362 Figure 3). Time-dependent Cox regression confirmed that incident CVD independently increased the risk of subsequent LREs (aHR: 1.93, 95% CI: 1.73–2.14, IDDF2026-ABS-0362 Figure 4). Integrated multi-omics analyses revealed correlations between cardiac dysfunction and hepatic parameters (IDDF2026-ABS-0362 Figure 5), and a shared proteomic signature enriched in immune and fibrotic pathways (IDDF2026-ABS-0362 Figure 6).Conclusions Patients with MASLD who experience a CVD have a higher risk of long-term LREs, highlighting the importance of monitoring liver health and initiating early treatment after CVD.Abstract IDDF2026-ABS-0362 Figure 1Abstract IDDF2026-ABS-0362 Figure 2Abstract IDDF2026-ABS-0362 Figure 3Abstract IDDF2026-ABS-0362 Figure 4Abstract IDDF2026-ABS-0362 Figure 5Abstract IDDF2026-ABS-0362 Figure 6