BACKGROUND: Metabolic dysfunction-associated fatty liver disease (MAFLD) and type 2 diabetes mellitus (T2DM) are independent risk factors for the development of cardiovascular disease (CVD) and an exaggerated CVD risk is expected when both diseases co-exist. Therefore, thorough risk stratification is important to inform better clinical practice decisions based on good quality evidence for patient with MAFLD and T2DM. AIM: To identify the CVD and cardiovascular event (CVE) risk in a systematic review when MAFLD and T2DM co-exist to inform better clinical practice decisions. METHODS: A systematic review was performed by compiling data by searching PubMed, EMBASE and Cochrane Library databases. Quality appraisal of retrieved studies and the meta-analysis were performed using Joanna Briggs Institute (JBI) tool and RevMan 5.4 software respectively. The effect indicators for CVE and CVD risk were expressed as odds ratios (OR) and 95%CI with -values < 0.05 as significant. RESULTS: Fourteen (5 cohort and 9 cross-sectional) studies with 370013 participants were included in this review. The meta-analysis of CVE showed that the risk of CVE in T2DM was higher in the MAFLD group when compared to the non-MAFLD group [OR 1.28 (95%CI, 1.04-1.56) = 0.02] with follow up duration ranging between 5-6 years. The prevalence of CVD in the metanalysis of cross-sectional studies was found to be higher [OR 1.47 (95%CI, 1.21-1.78) = 0.0001] in T2DM with MAFLD when compared to T2DM without MAFLD. Significant heterogeneity exists due to variations in study design, methodologies, and MAFLD diagnostic criteria, which may have influenced the study's findings. CONCLUSION: The presence of MAFLD in T2DM increased the risk of CVE. The prevalence of CVD is higher in T2DM with MAFLD as compared to T2DM without MAFLD. Large well-designed multicentric long-term prospective studies are necessary to appropriately risk stratify the cardiovascular effect of the MAFLD in T2DM patients.