Key result
High FIB-4 index is linked to ~104% higher carotid atherosclerosis risk in T2D.
Why the study?
The association between the fibrosis-4 index and diabetes-related vascular complications, particularly carotid atherosclerosis, in patients with type 2 diabetes mellitus required investigation.
Does an elevated FIB-4 index associate with an increased risk of carotid atherosclerosis in Chinese patients with type 2 diabetes mellitus?
Cross-Sectional (n=1,045)
No
Does an elevated FIB-4 index associate with an increased risk of carotid atherosclerosis in Chinese patients with type 2 diabetes mellitus?
Odds Ratio: 2.04 (95% CI 1.39–3)
Absolute Event Rate: 64.4% vs 47.5%
p-value: p=<0.001
An elevated FIB-4 index is independently associated with a higher risk of carotid atherosclerosis in patients with type 2 diabetes mellitus, suggesting its potential utility as a simple marker for macrovascular risk stratification.
FIB-4 may aid macrovascular risk stratification in T2DM; hypothesis-generating and requires prospective validation.
Objective: This study aimed to investigate the association between the fibrosis-4 (FIB-4) index and diabetes-related vascular complications in patients with type 2 diabetes mellitus (T2DM). The primary outcome was carotid atherosclerosis (CAS), with lower extremity arterial disease (LEAD) and diabetic peripheral neuropathy (DPN) as secondary outcomes. Methods: This cross-sectional study included 1,045 patients with T2DM. Logistic regression models were applied to assess associations between FIB-4 and the risks of CAS, LEAD, and DPN. Restricted cubic spline (RCS) analyses were conducted to evaluate potential nonlinear relationships. Receiver operating characteristic (ROC) curves were used to determine the discriminatory performance of FIB-4 for each outcome. Subgroup analyses were performed to assess the robustness of the associations across different patient strata. Results: Higher FIB-4 levels were associated with increased odds of CAS after adjustment for potential confounders. In the fully adjusted model, with the lowest FIB-4 quartile as the reference, odds ratios for CAS in the second, third, and fourth quartiles were 1.16 (95% CI: 0.79-1.72), 1.75 (95% CI: 1.19-2.58), and 2.04 (95% CI: 1.39-3.00), respectively. RCS analysis demonstrated a nonlinear association between FIB-4 and CAS risk (P < 0.001). Limited discriminatory performance of FIB-4 for CAS was observed, with an area under the curve (AUC) of 0.579 and an optimal cutoff value of 0.94. Weaker but similar associations were identified for LEAD and DPN, with slightly higher discriminatory ability for LEAD (AUC = 0.587) compared to DPN (AUC = 0.532). Subgroup analyses generally supported the stability of these findings. Conclusion: Elevated FIB-4 was significantly associated with higher risks of CAS and LEAD in patients with T2DM, with the strongest association observed for CAS. The association between FIB-4 and DPN did not reach statistical significance after multivariable adjustment. FIB-4 may serve as a simple and practical adjunct marker for risk stratification of diabetes-related macrovascular complications, particularly CAS, in T2DM.
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Huang et al. (2026) conducted a cross-sectional in Type 2 diabetes mellitus (n=1,045). Fibrosis-4 (FIB-4) index vs. Lowest FIB-4 quartile (Q1) was evaluated on Carotid atherosclerosis (CAS) (OR 2.04, 95% CI 1.39-3.00, p=<0.001). Elevated FIB-4 index was independently associated with a higher risk of carotid atherosclerosis in patients with type 2 diabetes, with the highest quartile showing a 2.04-fold increased odds compared to the lowest quartile.
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