Fibrinogen-to-albumin ratio predicts mortality in patients with diabetes mellitus and atherosclerotic cardiovascular disease.

Background: Circulating fibrinogen-to-albumin ratio (FAR) has been proposed as a novel inflammatory biomarker in patients with heart failure and malignant tumor. However, the prospective association in patients with atherosclerotic cardiovascular disease (ASCVD) remains to be investigated. Methods: The trial enrolled 821 patients with ASCVD from United States National Health and Nutrition Examination Survey from 1999-2002, with mortality follow-up through December 31st, 2019. Participants were divided into high-level FAR (FAR_H) and low-level FAR (FAR_L) groups. Kaplan-Meier and Cox proportional risk models were used to investigate the relationship between FAR and all-cause mortality in middle-aged and older persons with diabetes mellitus (DM). Results: During the median follow-up time of 15.6 years, 608 (weighted, 74.1%) ASCVD patients developed mortality. The incidence of mortality differed significantly between the FAR groups in patients with or without DM. Compared with FAR_L group, the FAR_H group has increased 90% mortality in the ASCVD patients with DM (HR = 1.90, 95%CI 1.22 - 3.00; P = 0.005). Moreover, the FAR and DM have a significant interaction (P = 0.016) in the ASCVD patients. Conclusions: In this prospective cohort study, a higher level of FAR was independently associated with 15-year mortality among ASCVD patients with DM. The combination of FAR and DM in ASCVD patients may aid in risk stratification and prognosis.