In light of evidence that cholesterol accumulation in hepatic stellate cells promotes NAFLD fibrosis35, it is tempting to speculate that TM6SF2 may act as a ‘switch’ with TM6SF2 rs58542926 T-allele-mediated hepatic retention of triglyceride and cholesterol predisposing to NAFLD fibrosis while C-allele carriage promotes VLDL excretion, protecting the liver at the expense of increased risk of cardiovascular disease. This evidence concerns the gene TM6SF2 and metabolic dysfunction-associated steatotic liver disease.