44% of NAFLD patients had severe CAD; 58% had a risk of severe CAD. hs-cTnI independently associated with severe CAD (OR 2.01, CI 1.37–2.93) and risk of CAD (OR 1.84, CI 1.14–2.96). NT-proBNP associated with cardiac dysfunction (elevated LVEDP/low EF). No link between liver fibrosis scores and CAD outcomes. Here, NPPB is linked to metabolic dysfunction-associated steatotic liver disease.