Time-updated FIB-4 index predicts coronary artery calcification progression in individuals with metabolic...

Area of Science:

• Cardiology
• Hepatology
• Radiology

Background:

• Metabolic dysfunction-associated steatotic liver disease (MASLD) is a prevalent chronic liver condition linked to increased cardiovascular disease (CVD) risk.
• Liver fibrosis, not steatosis, is the key prognostic factor in MASLD.
• The Fibrosis-4 (FIB-4) index is a noninvasive measure of liver fibrosis, but its predictive value for subclinical atherosclerosis is not well-established.

Purpose of the Study:

• To investigate the association between time-updated FIB-4 index and coronary artery calcification (CAC) progression.
• To determine if FIB-4 can predict subclinical atherosclerosis in asymptomatic adults with MASLD.

Main Methods:

• Analysis of a large cohort (60,445 participants) of asymptomatic Korean adults with repeated coronary CT and liver ultrasonography from 2012-2023.
• CAC progression defined as incident CAC or significant increase in existing CAC.
• Time-dependent Cox regression models used to assess the association between FIB-4 and CAC progression.

Main Results:

• Elevated FIB-4 was significantly associated with increased risk of CAC progression in MASLD patients, independent of traditional CVD risk factors.
• The association was more pronounced in men and individuals aged 40 years and older.
• Time-updated FIB-4 showed a modest association with subclinical atherosclerosis progression.

Conclusions:

• The time-updated FIB-4 index is modestly associated with subclinical atherosclerosis progression in MASLD patients, particularly men aged 40+.
• FIB-4 may serve as an accessible marker for subclinical cardiovascular risk in this population.
• Further research is needed to validate FIB-4 as a risk stratification tool for cardiovascular events.