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June 7, 2026Diabetes

Higher FIB-4 index in T2DM linked to ~31% higher MACE prevalence and increased mortality.

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Why the study?

The relationship between advanced liver fibrosis estimated by the FIB-4 index and ASCVD burden and outcomes in adults with T2DM remained unclear.

Does a higher Fibrosis-4 (FIB-4) index predict greater ASCVD burden, MACE, and mortality in adults with Type 2 Diabetes?

Population

8,900 adults with T2DM receiving care at Weill Cornell Medicine

Comparison

Low (<1.3) vs indeterminate (1.3-2.67) vs high (>2.67) FIB-4 index

Design

Unicenter retrospective registry study

Key result

In adults with T2DM, a higher FIB-4 index was associated with a stepwise increase in the prevalence of MACE (53.6% to 70.3%) and all-cause mortality (4.4% to 14.2%) (p≤0.001).

Authors

MMMelina I. ManolasSBSARAH BARENBAUMMYMichele Yeung

Discussion

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Overview

Supports FIB-4 as integrative marker in T2DM; leaves open incremental prognostic value beyond standard risks.

Key Points

  • This research aims to clarify the relationship between the FIB-4 index and ASCVD outcomes in adults with type 2 diabetes mellitus (T2DM).
  • Conducted a unicenter retrospective study of 8,900 adults with T2DM from 2016-2023
  • Identified T2DM and ASCVD using ICD-10 codes and laboratory data
  • Categorized FIB-4 into low, indeterminate, and high for outcome analysis.
  • 32.3% had low, 42.7% indeterminate, and 11.0% high FIB-4; higher FIB-4 linked to older age and chronic conditions
  • MACE prevalence increased across FIB-4 categories: 53.6% (low), 58.8% (indeterminate), 70.3% (high)
  • All-cause mortality rates also rose with FIB-4: 4.4% (low), 6.6% (indeterminate), 14.2% (high).

Study Design

Type

Cohort (n=8,900)

Multicenter

No

Structured PICO

Does a higher Fibrosis-4 (FIB-4) index predict greater ASCVD burden, MACE, and mortality in adults with Type 2 Diabetes?

P
Population
8,900 adults with type 2 diabetes receiving care at a single center between 2016 and 2023.
E
Exposure
High (>2.67) or indeterminate (1.3-2.67) Fibrosis-4 (FIB-4) index
C
Comparator
Low (<1.3) Fibrosis-4 (FIB-4) index
O
Outcome
ASCVD, MACE, and all-cause mortalitycomposite

Main Result

Absolute Event Rate: 70.3% vs 53.6%

p-value: p=≤0.001

In adults with T2DM, a higher FIB-4 index is significantly associated with increased prevalence of MACE, all-cause mortality, CAD, and stroke, suggesting its utility as an integrative cardiometabolic risk marker.

Cite This Study

Manolas et al. (2026) conducted a cohort in Type 2 Diabetes (n=8,900). High Fibrosis-4 (FIB-4) index (>2.67) vs. Low FIB-4 index (<1.3) was evaluated on Major adverse cardiovascular events (MACE) (p=≤0.001). In adults with T2DM, a higher FIB-4 index was associated with a stepwise increase in the prevalence of MACE (53.6% to 70.3%) and all-cause mortality (4.4% to 14.2%) (p≤0.001).

synapsesocial.com/papers/6a250b4c7def13d035e1b3efhttps://doi.org/10.2337/db26-1427-p
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 12979-LB: Clinical Utility of the FIB-4 Score in a Large Type 1 Diabetes Cohort2026
  2. 21405-P: Prediabetes Stage and Kidney Function Decline in Nondiabetic Adults: A Metabolic Liver–Kidney Link?2026
  3. 31352-P: Cardiometabolic Risk Factors Superior to FIB4 in Identifying Adults at Risk for NAFLD with Fibrosis2024
  4. 4Association of fibrosis index-4 (FIB-4) with chronic vascular complications of type 2 diabetes mellitus2025 · 1 citations
  5. 5The Association Between Fibrosis‐4 Index and All‐Cause and Cardiac Mortality in Patients With Coronary Heart Disease Combined With Diabetes or Prediabetes: Findings From Two Large‐Scale Prospective Cohort Studies2026 · 1 citations