ArticleThe Journal of clinical endocrinology and metabolism2025
Incremental Value of Blood-Based Markers of Liver Fibrosis in Cardiovascular Risk Stratification.
Article in The Journal of clinical endocrinology and metabolism, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 9 papers.
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Who cites it
9 citing papers in PubMed.
- Associations between cardiometabolic traits and diabetic cardiomyopathy: an imaging-based analysis.Acta diabetologica · 2026Article
- FIB-4 predicts coronary disease and early outcomes in unstable angina pectoris.Internal and emergency medicine · 2026Article
- The association between liver fibrosis markers and carotid atherosclerosis in non-alcoholic fatty liver disease is strongly influenced by age.BMC cardiovascular disorders · 2026Article
- Association of the fibrosis-4 index with early-stage cardiovascular-kidney-metabolic syndrome in a longitudinal community-based cohort.Frontiers in public health · 2026Article
- Amyloid-beta (1-40) peptide is associated with systemic metabolic health.European journal of clinical investigation · 2026Article
- Reliability of B-mode ultrasound measurement of carotid intima-media thickness in assessing cardiovascular risk: a cross-sectional study.Frontiers in cardiovascular medicine · 2026Article
- A Positive Correlation of Basal Metabolic Rate With Significant Liver Fibrosis in Adults With MASLD and Obesity: Results From NHANES 2017-2020.Canadian journal of gastroenterology & hepatology · 2026Article
- A negative correlation of low estimated glucose disposal rate with significant liver fibrosis in adults with NAFLD and obesity: results from NHANES 2017-2020.BMC gastroenterology · 2025Article
- TyG index and MAFLD severity are associated with subclinical LV dysfunction in T2DM patients: a cross-sectional study.Frontiers in endocrinology · 2025Article
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Authors and funding
16 authors.
Funding
Abstract
contextNonalcoholic fatty liver disease (NAFLD) with advanced liver fibrosis is associated with cardiovascular disease (CVD).
objectiveThis work aimed to examine if markers of vascular injury mediate the link between liver fibrosis noninvasive tests (LFNITs) and CVD events, and to compare the incremental predictive value of LFNITs over established CVD risk scores.
methodsConsecutively recruited individuals (n = 1692) with or without clinically overt coronary artery disease (CAD) from the Athens Cardiometabolic Cohort, were analyzed. Fibrosis-4 index (FIB-4), NAFLD Fibrosis score (NFS), and BARD score were evaluated for direct and indirect associations with indices of subclinical arterial injury including carotid maximal wall thickness (maxWT) and pulse wave velocity (PWV) and with a composite of major adverse cardiovascular events (MACE) that consisted of cardiac death, acute myocardial infarction, or coronary revascularization (39-month median follow-up).
resultsFIB-4 was the only LFNIT that was consistently associated with multiple markers of vascular injury, irrespective of CAD presence and after controlling for traditional risk factors, surrogates of insulin resistance, or obesity (adjusted P < .05 for all). FIB-4 was also independently associated with CAD presence (adjusted odds ratio [OR] 6.55; 3.48-12.3; P < .001). Increased FIB-4 greater than 2.67 was incrementally associated with an increased risk for MACE (OR [95% CI] 2.00 [1.12-3.55], ΔAUC [95% CI] 0.014 [0.002-0.026]). These associations were mediated by maxWT rather than PWV. Only FIB-4 (>3.25) was independently and incrementally associated with all-cause mortality (adjusted P < 0.05).
conclusionIn a cardiometabolically diverse population, the incremental associations of LFNITs with CVD outcomes were mediated by atherosclerotic burden rather than arterial stiffening. FIB-4 consistently demonstrated associations with all study end points. These findings provide mechanistic insights and support the clinical applicability of FIB-4 in CVD prevention.
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