SummaryBackgroundNonalcoholic fatty liver disease (NAFLD) and type 2 diabetes mellitus (T2DM) are independent risk factors for cardiovascular disease (CVD).AimsTo examine the clinical utility of liver fat quantification for determining CVD risk among a well‐phenotyped cohort of patients with T2DM.MethodsThis was a cross‐sectional analysis of a prospective cohort of adults aged ≥50 with T2DM. Liver fat was quantified with magnetic resonance imaging proton‐density‐fat‐fraction (MRI‐PDFF), an advanced imaging‐based biomarker. Patients were stratified into a higher liver fat group (MRI‐PDFF ≥ 14.6%), and a lower liver fat group (MRI‐PDFF < 14.6%). The co‐primary outcomes were CVD risk determined by Framingham and Atherosclerotic Cardiovascular Disease (ASCVD) risk scores. High CVD risk was defined by risk scores ≥20%.ResultsOf the 391 adults (66% female) in this study, the mean (±SD) age was 64 (±8) years and BMI 30.8 (±5.2) kg/m², respectively. In multivariable analysis, adjusted for age, gender, race, and BMI, patients in the higher liver fat group had higher CVD risk [OR = 4.04 (95% CI: 2.07–7.88, p < 0.0001)] and ASCVD risk score [OR = 2.85 (95% CI: 1.19–6.83, p = 0.018)], respectively.ConclusionHigher liver fat content increases CVD risk independently of age, gender, ethnicity and BMI. These findings raise the question whether liver fat quantification should be incorporated into risk calculators to further stratify those with higher CVD risk.