REN and metabolic dysfunction-associated steatotic liver disease: However, the underlying mechanisms by which NAFLD increases the risk of CVD have not been well established; they are complex and may involve insulin resistance (associated with high serum levels of oxidized-LDL and glycated-LDL), systemic inflammation, oxidative stress, neuroendocrine activation (renin-angiotensin system and sympathetic nervous system may exacerbate cardiac remodeling), imbalance of procoagulant and anticoagulant factors, hepatokine imbalance, which can induce metabolic abnormalities, dysbiosis of the gut microbiota and genetics [2, 37, 38].