Abstract
Background
A growing body of evidence suggests that Non-alcoholic fatty liver disease (NAFLD)
and liver fibrosis are associated with cardiovascular disease (CVD). However, the
independent role of liver fibrosis markers in the prediction of CVD in the general
population is seldom tested.
Aims
To assess whether a marker of liver fibrosis predicts the first occurrence of a CVD
event in a large sample of community-based general population.
Methods
Historical cohort using data from a large health provider that operates a centralized
computerized medical record. The level of liver fibrosis was measured by the fibrosis-4
(FIB-4) score, and the association with CVD was adjusted for the European Systematic
Coronary Risk Evaluation calculator (SCORE).
Results
The study included 8,511 individuals, 3,292 with inconclusive fibrosis and 195 with
advanced fibrosis (FIB-4 ≥ 2.67). People with advanced fibrosis had higher risk for
CVD, after adjustment for sociodemographic characteristics, the SCORE, use of statins
and aspirin (HR [95%CI], 1.63 [1.29–2.06]). The association persisted in both women
and men. Using age-specific cut-offs, there was a dose-response association between
inconclusive and advanced fibrosis and CVD (HR [95%CI], 1.15 [1.01–1.31]) and HR [95%CI],
1.60 [1.27–2.01], respectively, P for trend<0.001).
Conclusions
A simple fibrosis score is independently associated with CVD, suggesting that fibrosis
markers should be considered in primary-care risk assessment.
Keywords
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Article info
Publication history
Published online: November 01, 2020
Accepted:
October 13,
2020
Received:
July 30,
2020
Identification
Copyright
© 2020 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.
ScienceDirect
Access this article on ScienceDirectLinked Article
- Assessment of hepatic fibrosis in MAFLD: A new player in the evaluation of residual cardiovascular risk?Digestive and Liver DiseaseVol. 53Issue 3
- PreviewWe read with great interest the recently published paper by Shonmann et al. [1] reporting on an independent positive association between liver fibrosis and ten-year incidence of cardiovascular events (CVEs) in a large sample of community-based general population in Israel. Fibrosis was non-invasively assessed by the FIB-4 score, a simple and well validated score used to rule out (cut-off value ≤1.3) or rule in (cut-off ≥2.67) significant liver fibrosis (F2-F3) [2,3]. These results are of considerable interest since they suggest that hepatic fibrosis could therefore be interpreted as an additional non-lipid marker of residual cardiovascular risk, defined as the risk that remains after the optimal multifactorial treatment of all the coexisting risk factors in the individual.
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