Progression of FIB-4 index predicts major adverse cardiovascular events in patients with metabolic dysfunction

Metabolic dysfunction is highly prevalent worldwide and is associated with metabolic dysfunction-associated steatotic liver disease and an increased risk of cardiovascular disease. However, it remains unclear whether non-invasive tests assessing liver disease severity can predict major adverse cardiovascular events (MACEs).

We aimed to explore the relationship between changes in fibrosis-4 scores (FIB-4) and MACEs in patients with metabolic dysfunction.

We conducted a retrospective cohort study including participants from a primary care clinic between 2009 and 2021, focusing on adults with metabolic dysfunction - risk of MASLD. We used FIB-4 to track MACEs over a 10-year follow-up period. Adjusted binomial regression models evaluated associations between FIB-4 progression (change in at least one stage of risk) and MACEs.

We included 695 patients with a median age of 63.5 years [IQR 56-74]; 34.6% were women. Among them, 29% had diabetes mellitus, 21.5% had prediabetes, 58.1% had hypertension, and 93.3% had dyslipidemia. Patients who developed MACEs were older, had a higher proportion of men, and showed greater prevalence of hypertension, dyslipidemia, and obesity. Both baseline and final FIB-4 scores were higher in patients with MACEs. Adjusted analysis showed that FIB-4 progression was associated with a 106% increased risk of myocardial infarction (RR=2.06, 95% CI: 1.34-3.15; p=0.001), but not with an increased risk of stroke (RR=1.13, 95% CI: 0.73-1.74; p=0.591). Conversely, reductions in FIB-4 were protective for MI.

Progression and reduction in FIB-4 scores are associated with an increased and decreased risk of myocardial infarction, respectively, in patients with metabolic dysfunction.