Clinically Accessible Liver Fibrosis Association with CT Scan Coronary Artery Disease Beyond Other Validated Risk Predictors: The ICAP Experience
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Published on: August 28, 2018
Belén García Izquierdo1,2, Diego Martínez-Urbistondo2,3, Sonsoles Guadalix1,2
1Department of Endocrinology, Clínica Universidad de Navarra, 28027 Madrid, Spain.
Insights
Identifying higher-than-expected coronary artery disease (CAD) in asymptomatic patients is crucial. Liver fibrosis indicators and obesity can help refine cardiovascular risk (CVR) stratification, guiding targeted CT scan coronarography assessments.
Area of Science:
- Cardiovascular Medicine
- Radiology
- Preventive Cardiology
Background:
- Current cardiovascular risk (CVR) stratification methods have limitations in clinical practice.
- Improved identification of higher-than-expected coronary artery disease (CAD) is needed, particularly in asymptomatic individuals.
- Coronary CT angiography (CCTA) is a key imaging modality for CAD assessment.
Purpose of the Study:
- To evaluate clinical parameters for enhancing CVR stratification in asymptomatic patients undergoing CCTA.
- To identify specific factors associated with 'CVR excess'—higher-than-expected CAD—in different CVR strata.
- To explore the role of liver fibrosis risk (FIB-4) in modifying CVR assessment.
Main Methods:
- Cross-sectional study of 219 asymptomatic volunteers (aged 40-80) from the Integrated Cardiovascular Assessment Program (ICAP).
- Assessment of CVR factors including obesity, lipid profiles, FIB-4 score, C-reactive protein, and family history.
- Stratification into low-to-moderate (LMR), high (HR), and very-high-risk (VHR) groups per ESC guidelines; 'CVR excess' defined by CAD-RADS scores relative to risk group.
Main Results:
- Overall, 18% of LMR, 15% of HR, and 19% of VHR patients exhibited 'CVR excess'.
- LMR patients with prior statin use and HR patients with obesity were more likely to have 'CVR excess' (p < 0.01 and p < 0.05, respectively).
- FIB-4 score significantly modified the predictive impact of statin use and obesity on 'CVR excess' (p for interactions < 0.05). Predictive models showed strong discrimination (AUROC 0.84 for LMR, 0.82 for HR).
Conclusions:
- Suspected liver fibrosis combined with statin use in LMR patients is linked to 'CVR excess'.
- Obesity in HR patients is also associated with 'CVR excess'.
- These findings suggest potential indications for CCTA in asymptomatic individuals based on specific clinical profiles.
Abstract:
Background/objectives: Cardiovascular risk (CVR) stratification in clinical settings remains limited. This study aims to evaluate clinical parameters that could improve the identification of higher-than-expected coronary artery disease (CAD) in CT scan coronarography. Methods: In a cross-sectional study of asymptomatic patients from the Integrated Cardiovascular Assessment Program (ICAP), volunteers aged 40-80 without diagnosed cardiovascular disease were assessed. CVR factors like obesity, lipid and glucose profiles, liver fibrosis risk (FIB-4 ≥ 1.3), C-reactive protein, and family history of CVD were evaluated. Patients were stratified by CVR following ESC guidelines. "CVR excess" was defined as CAD-RADS ≥ 2 in low-to-moderate-risk (LMR), CAD-RADS ≥ 3 in high-risk (HR), and CAD-RADS ≥ 4 in very-high-risk (VHR) groups. Results: Among 219 patients (mean age 57.9 ± 1.15 years, 14% female), 43.4% were classified as LMR, 49.3% as HR, and 7.3% as VHR. "CVR excess" was observed in 18% of LMR, 15% of HR, and 19% of VHR patients. LMR patients with prior statin use and HR patients with obesity were more likely to have "CVR excess" (p < 0.01 and p < 0.05, respectively). FIB-4 modified the effect of statin use and obesity on "CVR excess" prediction (p for interactions < 0.05). Models including age, sex, and both interactions showed a strong discrimination for "CVR excess" in LMR and HR groups (AUROC 0.84 (95% CI 0.73-0.95) and 0.82 (95% CI 0.70-0.93), respectively). Conclusions: Suspected liver fibrosis combined with statin use in LMR patients and obesity in HR patients is associated with CVR excess, providing potential indications for image CAD assessment in asymptomatic patients.
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