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Aim: Non-alcoholic fatty liver disease (NAFLD) and type 2 diabetes mellitus (T2DM) have a synergistic effect on cardiovascular disease (CVD). We investigated the association of changes in hepatic steatosis and advanced hepatic fibrosis with risk of CVD and mortality in new-onset T2DM.Methods: Using the Korean National Health Insurance dataset, we included 120,256 patients with new-onset T2DM. Hepatic steatosis and advanced hepatic fibrosis were determined using the fatty liver index (FLI) and BARD score. According to the changes of the two scores over two years, patients were divided into four groups and analyzed for development of myocardial infarction (MI), stroke, heart failure (HF), and mortality.Results: Incident hepatic steatosis was associated with increased development of stroke, HF, and mortality compared with non-NAFLD (all p < 0.05). Regression and persistent hepatic steatosis were associated with increased risk of MI, stroke, HF, and mortality compared with non-NAFLD (all p < 0.05). Persistent advanced hepatic fibrosis was associated with increased risk of stroke, HF, and mortality (all p < 0.05).) Compared with persistent hepatic fibrosis, regression of hepatic fibrosis was associated with decreased risk of stroke, HF, and mortality (all p < 0.05).Conclusions: Changes in FLI or BARD score were associated with CVD and mortality in new-onset T2DM. [ABSTRACT FROM AUTHOR]