MASLD in chronic hepatitis B was associated with higher cardiovascular and extrahepatic cancer risks over 13.7 years. MASLD in Chronic Hepatitis B Signals Systemic RiskMASLD in chronic hepatitis B was associated with higher cardiovascular and extrahepatic cancer risks over 13.7 years. The population-based cohort study included 3,269 adults with chronic hepatitis B virus infection from northern China. Cardiovascular Disease Risk Remained ElevatedThe 12-year cumulative incidence of cardiovascular disease was 9.4% among participants with MASLD, compared with 4.9% among those without MASLD. Instead, the joint analysis identified a synergistic interaction between chronic hepatitis B and cardiometabolic risk factors in primary liver cancer development.