TOPLINE

Participants without clinical liver disease who had high scores for liver steatosis, fibrosis, and functional impairment had a substantially increased risk of developing cardiovascular disease (CVD).

METHODOLOGY

• Researchers analyzed data from the prospective UK Biobank cohort to assess whether three noninvasive indices of subclinical liver disease could independently or jointly predict the future risk for CVD.
• They included 318,308 participants who were free of clinical liver disease and CVD at baseline and were recruited across the UK between 2006 and 2010; the median age was 57 years, and 44.3% were men.
• Researchers evaluated the fatty liver index (FLI) for hepatic steatosis, the fibrosis-4 index (FIB-4) for fibrosis, and the albumin-bilirubin (ALBI) score for hepatic function. Participants were grouped into sex-specific quartiles for each score.
• The primary endpoint was a composite of first myocardial infarction, atrial fibrillation, heart failure, stroke, and cardiovascular death. The median duration of follow-up was 14.0 years.
• The analyses were adjusted for multiple factors, including age; sex; and several cardiovascular risk factors such as smoking, diabetes, high blood pressure, and cholesterol levels.

TAKEAWAY

• A total of 32,637 incident events of CVD (10.25%) occurred over the follow-up period. The risk for CVD was 46%, 66%, and 42% higher among participants in the highest vs lowest quartiles of FLI, FIB-4, and ALBI, respectively (P < .001 for all).
• Having all three indices in the highest quartile was associated with more than double the risk for CVD compared with having none in the highest quartile (adjusted hazard ratio, 2.53; P < .001).
• FLI was more strongly associated with the risk for CVD in women, whereas FIB-4 and ALBI showed stronger associations in men.
• Researchers identified specific cutoff values for each marker that best predicted the risk for CVD: an FLI of 43.7 or higher, a FIB-4 of 1.25 or higher, and an ALBI score of -2.40 or higher.

IN PRACTICE

"[The] findings introduce a liver-heart axis framework into cardiovascular risk prediction, supporting the integration of noninvasive liver biomarkers into current prevention paradigms to identify high-risk individuals overlooked by traditional assessments," the researchers wrote.

SOURCE

The study was led by Le Li, Fuwai Hospital, Chinese Academy of Medical Sciences in Beijing, China. It was published online on September 7 in European Heart Journal.

LIMITATIONS

FLI, FIB-4, and ALBI were not direct histologic measures. Exposure used only baseline measurements and did not account for changes over time. Residual confounding from unmeasured factors such as genetic predisposition or dietary habits could not be completely ruled out.

DISCLOSURES

The study received support from the Noncommunicable Chronic Diseases-National Science and Technology Major Project and the Chinese Academy of Medical Sciences Innovation Fund for Medical Sciences. The authors did not declare any conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.