The study investigated the effect of PCSK9 inhibitors (PCSK9i) on patients with metabolic liver dysfunction (MAFLD) and type 2 diabetes (T2DM). Forty patients were divided into a control group (n=30, atorvastatin 20 mg daily) and a PCSK9i group (n=30, evolocumab 140 mg every 2 weeks plus atorvastatin). Lipid profile (TC, LDL-C, HDL-C, triglycerides), BMI, glycemic control and surrogates of hepatic steatosis (APRI, FIB-4, FLI, CAP) at baseline and after 12 weeks were analyzed. Both groups had significant reductions in lipids, but the PCSK9i group achieved a greater reduction in TC by 48.65% (vs. 23.32%) and LDL-C by 50% versus control (P < 0.05). The PCSK9i group had a significantly greater reduction in CAP by 22.41% (vs. 15.60%) and FLI by 27.72% (vs. 13.77%); both P < 0.05. Regression analyzes confirmed that the improvement of CAP and FLI with PCSK9i is independent of SGLT-2i treatment. PCSK9i effectively reduced liver steatosis surrogate scores (FLI, CAP) and lipids (TC, LDL-C) in patients with MAFLD and T2DM.