Related Experiment Video
Updated: Jan 10, 2026
Author Spotlight: Advancing Cardiovascular Imaging - Introducing the Spatially Weighted Calcium Score for Early Disease Detection
Published on: September 22, 2023
FIB-4 Serves as a Referral Index for Coronary Artery Calcification in Patients With MASLD
Ya-Chin Huang1,2,3,4,5, Chih-Wen Wang6,7, Jiun-Chi Huang8,9
1Department of Preventive Medicine, Kaohsiung Medical University Gangshan Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.
Insights
Metabolic dysfunction-associated steatotic liver disease (MASLD) is linked to coronary artery calcification (CAC). The Fibrosis-4 (FIB-4) index can help identify MASLD patients at higher risk for coronary atherosclerosis, aiding early intervention.
Area of Science:
- Cardiology
- Hepatology
- Radiology
Background:
- The relationship between metabolic dysfunction-associated steatotic liver disease (MASLD), liver fibrosis, and coronary artery calcification (CAC) requires further investigation.
- The predictive value of the Fibrosis-4 (FIB-4) index in this context is uncertain.
Purpose of the Study:
- To investigate the associations between MASLD, liver fibrosis (using FIB-4), and CAC.
- To evaluate the predictive performance of the FIB-4 index for CAC at various thresholds.
Main Methods:
- A study of 6058 individuals undergoing health check-ups and coronary computed tomography.
- MASLD identification via ultrasonography or hepatic steatosis index; MASLD defined by steatotic liver disease plus cardiometabolic risk factors.
- Liver fibrosis assessed using the FIB-4 index; association with CAC and predictive performance analyzed.
Main Results:
- MASLD prevalence was 39.8%, with higher CAC prevalence (51.1%) compared to non-MASLD individuals (42.5%).
- Independent predictors for CAC included age, male gender, MASLD, and FIB-4 index.
- In MASLD patients, CAC prevalence increased with FIB-4 values and cardiometabolic burden; FIB-4 values correlated with coronary artery calcium scores.
Conclusions:
- MASLD patients with elevated FIB-4 scores face an increased risk of coronary atherosclerosis.
- Integrating FIB-4 into routine assessments can identify high-risk individuals for early cardiology referral and preventive care.
Background/Aims:
The association between metabolic dysfunction-associated steatotic liver disease (MASLD), liver fibrosis, and coronary artery calcification (CAC) remains uncertain. We investigated their relationships and the predictive role of the Fibrosis-4 (FIB-4) index.
Methods:
The study included 6058 subjects undergoing health check-ups and coronary computed tomography. Steatotic liver disease (SLD) was identified via ultrasonography or hepatic steatosis index > 36. MASLD was defined as SLD with at least one of the five cardiometabolic risk factors. Liver fibrosis severity was assessed using the FIB-4 index to assess its association with CAC and predictive performance at different CAC thresholds.
Results:
MASLD was present in 39.8% of participants, with a higher CAC prevalence than non-MASLD individuals (51.1% vs. 42.5%, p < 0.001). Factors associated with the presence of CAC included age (odds ratio [OR]/95% confidence intervals [CI]: 1.117/1.106-1.128, p < 0.001), male gender (OR/95% CI: 4.448/3.660-5.406, p < 0.001), MASLD (OR/95% CI: 1.570/1.342-1.837, p < 0.001), and FIB-4 (OR/95% CI: 1.217/1.034-1.433, p = 0.018). Among MASLD subjects, the prevalence of CAC increased with FIB-4 value and cardiometabolic burdens. FIB-4 values increased progressively in patients with higher coronary artery calcium scores (p-trend < 0.001). A FIB-4 cut-off of ≥ 2.67 provided the highest positive predictive value (89.7%) for the presence of CAC, while a cut-off of 1.26 offered the best negative predictive value (95.1%) for severe CAC.
Conclusion:
MASLD patients with elevated FIB-4 are at increased risk of coronary atherosclerosis. Incorporating FIB-4 into routine assessment may help identify high-risk individuals who could benefit from early cardiology referral and preventive cardiovascular care.
