High fibrosis-4 index predicts the new onset of ischaemic heart disease during a 10-year period in a general population - PubMed (original) (raw)

High fibrosis-4 index predicts the new onset of ischaemic heart disease during a 10-year period in a general population

Yukimura Higashiura et al. Eur Heart J Open. 2022.

Abstract

Aims: The fibrosis-4 (FIB-4) index, calculated using age, platelet count, and levels of aspartate aminotransferase and alanine aminotransferase, is a non-invasive indicator for the detection of liver fibrosis. Advanced hepatic fibrosis is associated with morbidity and mortality in patients with non-alcoholic fatty liver disease. However, the relationship between liver fibrosis and the development of ischaemic heart disease (IHD) has not fully been addressed.

Methods and results: We investigated the association between the FIB-4 index and the new onset of IHD during a 10-year period in a general population of subjects who received annual health examinations (n = 28 990). After exclusion of subjects with missing data and those with a history of IHD at baseline, a total of 13 448 subjects (men/women: 8774/4674, mean age: 48 years) were included. During the 10-year period, 378 men (4.3%) and 77 women (1.6%) had a new onset of IHD. Multivariable Cox proportional hazard models with a restricted cubic spline showed that hazard risk for the development of IHD increased with a higher FIB-4 index at baseline after adjustment of age, sex, fatty liver (FL) determined by ultrasonography, estimated glomerular filtration rate, habits of current smoking and alcohol drinking, family history of IHD, and diagnosis of hypertension, diabetes mellitus and dyslipidaemia. When divided by FL, the FIB-4 index becomes an independent predictor for the development of IHD in subjects with FL but not in those without FL. The addition of the FIB-4 index to traditional risk factors for IHD significantly improved the discriminatory capability.

Conclusion: A high level of the FIB-4 index predicts the new onset of IHD during a 10-year period.

Keywords: Biomarker; Coronary heart disease; Hepatic fibrosis.

© The Author(s) 2022. Published by Oxford University Press on behalf of the European Society of Cardiology.

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Figures

Graphical abstract

Graphical abstract

High FIB-4 index predicts the development of ischemic heart disease (IHD).

Figure 1

Figure 1

Flow chart of the selected study participants. Among 28 990 subjects enrolled in 2006, a total of 13 448 subjects (men/women: 8774/4674) were finally included for analyses in the present study. eGFR, estimated glomerular filtration rate; FIB-4, fibrosis-4; IHD, ischaemic heart disease.

Figure 2

Figure 2

Hazard ratios for the development of ischaemic heart disease by the fibrosis-4 index at baseline. (A–C) Hazard ratios for the development of ischaemic heart disease by the fibrosis-4 index at baseline analyzed by multivariable Cox proportional hazard models with a restricted cubic spline after adjustment of age, sex, presence of fatty liver, habits of current smoking and alcohol drinking, family history of ischaemic heart disease and diagnosis of diabetes mellitus, hypertension, and dyslipidaemia at baseline in all of the subjects (A) as well as in subjects with fatty liver (B) and those without fatty liver (C). Solid line: HR; dashed line: 95% confidence interval. The reference values of the fibrosis-4 index were 0.27 as minimum values.

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