ALB and diabetes mellitus: SHapley Additive exPlanations analysis revealed that older age, higher NFS (particularly > -1.0), and lower albumin (<3.5 g/dL) were the strongest drivers of CVD risk, with NFS showing clear threshold effects.<h4>Conclusion</h4>The findings confirm that traditional cardiovascular risk assessment approaches are insufficient for MAFLD patients, as liver-specific markers-particularly hepatic fibrosis (NFS) and liver synthetic function (albumin)-dominated cardiovascular risk prediction over conventional risk factors (hypertension, diabetes, smoking).