- Design
- Prospective cohort study, multivariable-adjusted Cox models
- Population
- 318,308 adults free of liver and cardiovascular disease at baseline
- Primary outcome
- Incident major cardiovascular events over median 14 years
- Effect
- Top-quartile FIB-4 aHR 1.66 (1.60-1.73); all three markers top-quartile aHR 2.53 (2.38-2.70)
A prospective cohort of 318,308 adults free of liver and cardiovascular disease at baseline linked three non-invasive liver measures, the fatty liver index, FIB-4 for fibrosis and the albumin-bilirubin score, to incident cardiovascular events over a median 14 years.
Each independently predicted cardiovascular disease: top-quartile FIB-4 carried an adjusted hazard ratio of 1.66 (95% CI 1.60 to 1.73), with the fatty liver index at 1.46 and albumin-bilirubin at 1.42. People in the top quartile of all three had an adjusted hazard ratio of 2.53. The fatty liver index was more predictive in women, FIB-4 and albumin-bilirubin in men.
FIB-4 is calculated from age, transaminases and platelets, values often already on the chart, so this is actionable without new tests: a raised FIB-4 in a patient you are risk-stratifying is a reason to look harder at cardiovascular risk, not only at the liver. It is observational, so it refines risk assessment rather than defining a treatment target.
- FIB-4, computed from routine age, transaminases and platelets, independently predicted cardiovascular events (aHR 1.66).
- The fatty liver index and albumin-bilirubin score added further, sex-specific prediction.
- Top quartile on all three markers more than doubled cardiovascular risk (aHR 2.53).
- Read a raised FIB-4 as a cardiovascular signal, not only a hepatic one.
- Use it to sharpen risk assessment, not as a new treatment target.
Why it matters
It turns liver numbers already in the record into usable cardiovascular risk information.
Don't overread it
This is observational; the liver indices mark risk and are not shown to be modifiable cardiovascular targets.
The statistics, in plain English
Hazard ratios above 1 mean higher risk, and the narrow confidence intervals reflect the very large cohort; because it is observational, these markers flag risk rather than prove that treating the liver lowers it.
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