Cardiovascular disease (CVD) is the leading cause of death in NAFLD patients. Increased plasma proneurotensin (pro-NT) levels were found to identify the presence and severity of NAFLD. The association between pro-NT and incident major cardiovascular events has been confirmed. Aims To evaluate the association of serum pro-neurotensin with cardiovascular risk in NAFLD patients. Methods A cross-sectional cohort included sixty patients with NAFLD and documented CVD, sixty patients with NAFLD without documented CVD and 60 healthy controls. Liver function tests, liver enzymes, lipid profile, fasting blood glucose, abdominal ultrasound and serum proneurotensin were done. Results Proneurotensin was significantly higher in the NAFLD group as compared to controls, P <0.0001. Proneurotensin levels were significantly higher in patients with established CVD in addition to NAFLD as compared to NAFLD only patients P <0.0001. Serum proneurotensin showed significant positive correlation with Framingham score and NAFLD Fibrosis Score P <0.0001. Reciever operating characteristic (ROC) curve demonstrated a cut-off value >24.5 ng/L for proneurotensin as a predictor of NAFLD with 64.2% sensitivity and 96.7% specificity, (AUC) = 0.862, P < 0.001. And a cut-off value >28.5 ng/L for proneurotensin as a predictor of CVD in NAFLD patients, with 83.3% sensitivity and 78.3% specificity, (AUC) = 0.854, P < 0.001. Conclusions serum proneurotensin is significantly higher in NAFLD patients established CVD than NAFLD only patients and healthy subjects. It can be considered as a marker of CVD risk in such patients.