Fibrosis-4 index predicts cardiovascular events in NAFLD

The fibrosis-4 index (FIB-4) is strongly and independently associated with major adverse cardiovascular events (MACE), beyond established cardiovascular risk factors and baseline liver diagnosis, among patients with nonalcoholic fatty liver disease (NAFLD), nonalcoholic steatohepatitis (NASH), or at risk of NASH, a study in the real-world setting has shown.

A team of investigators analysed data from 81,108 patients (mean age 62 years, 49.6 percent men) with a diagnosis of NAFLD, NASH, or at risk of NASH to determine whether FIB-4 can identify those at highest risk of cardiovascular events. MACE, the primary outcome, was characterized by myocardial infarction (MI), hospitalization for unstable angina or heart failure, and coronary revascularization.

A total of 67,273 patients had no previous cardiovascular disease, of whom 9,112 (13.5 percent) experienced MACE over a median follow-up of 3 years. Univariate analysis revealed FIB-4 ≥2.67 as the most robust independent predictor of MACE overall (hazard ratio [HR], 1.82, 95 percent confidence interval [CI], 1.63‒2.04; p<0.001) and across all baseline groups.

FIB-4 ≥2.67 continued to be the strongest predictor of MACE overall (adjusted [a]HR, 1.80, 95 percent CI, 1.61‒2.02; p<0.001) after adjusting for established cardiovascular risk factors. Likewise, it consistently correlated with MI (aHR, 1.46, 95 percent CI, 1.25‒1.70; p<0.001), hospitalization for unstable angina (aHR, 1.24, 95 percent CI, 1.03‒1.49; p=0.025), hospitalization for heart failure (aHR, 2.09, 95 percent CI, 1.86‒2.35; p<0.001), coronary artery bypass graft (aHR, 1.65, 95 percent CI, 1.26‒2.17; p<0.001), and percutaneous coronary intervention (aHR, 1.72, 95 percent CI, 1.21‒2.45; p=0.003).