Key result
Elevated FIB-4 score linked to ~34% higher odds of CAD in MAFLD patients.
Why the study?
Although liver fibrosis scores are linked to cardiovascular disease in NAFLD, their relationship with CAD severity in patients with MAFLD remained to be investigated.
Are non-invasive liver fibrosis scores (FIB-4, NFS, and APRI) associated with coronary artery disease severity and coronary artery calcium scores in patients with metabolic dysfunction-associated fatty liver disease (MAFLD)?
Cross-Sectional (n=1,346)
Single-blind (radiologists blinded to clinical and laboratory data)
No
Are non-invasive liver fibrosis scores (FIB-4, NFS, and APRI) associated with coronary artery disease severity and coronary artery calcium scores in patients with metabolic dysfunction-associated fatty liver disease (MAFLD)?
Non-invasive liver fibrosis scores (FIB-4 and NFS) are independently associated with coronary artery disease severity and coronary artery calcium scores in patients with MAFLD, supporting their utility for cardiovascular risk stratification.
Answers are grounded in this paper and cite their sources.
Liver fibrosis scores were associated with CAD in MAFLD; leaves open utility for risk stratification pending prospective validation.
Background: Metabolic dysfunction-associated fatty liver disease (MAFLD) is a recently proposed term as a more appropriate definition for nonalcoholic fatty liver disease (NAFLD). Previous studies have shown an association between liver fibrosis scores and cardiovascular disease (CVD) in patients with NAFLD. In this study, we aimed to investigate the relationship between liver fibrosis scores and coronary artery disease (CAD) severity in patients with MAFLD. Methods: This study was conducted on 1346 patients with MAFLD at the Second Hospital of Dalian Medical University between January 2018 and December 2021. We calculated the liver fibrosis scores, including the fibrosis 4 (FIB-4) score, nonalcoholic fatty liver disease fibrosis score (NFS), and aspartate aminotransferase-to-platelet ratio index (APRI). We divided the participants into three groups based on the degree of coronary artery stenosis assessed using coronary computed tomography angiography (CCTA): CAD (≥50%), non-obstructive (1-49%), and normal (no stenosis). Results: An increased FIB-4 score and NFS were significantly associated with CAD severity in patients with MAFLD. The percentage of patients with a high FIB-4 score was higher in the CAD group than in the other two groups (5.80%, 4.31%, and 2.24%, respectively; p<0.001), as was the percentage of patients with NFS (11.12%, 5.19%, and 0.93%, respectively; p<0.001). Carotid atherosclerosis, creatinine levels, and CAC scores were significant predictors of CAD. The FIB-4 score and NFS were independently associated with CAD even after adjusting for sex and well-known cardiovascular risk factors. The APRI was not a significant factor for CAD in any model. In the bivariate correlation analysis, the FIB-4 score and NFS were directly correlated with CAC scores. Conclusion: Non-invasive liver fibrosis scores (FIB-4 and NFS) were significantly associated with the CAD severity and CAC scores in patients with MAFLD. Screening for CAD may be beneficial for subjects with high liver fibrosis risk MAFLD.
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Lu et al. (2023) conducted a cross-sectional in Metabolic dysfunction-associated fatty liver disease (MAFLD) (n=1,346). Non-invasive liver fibrosis scores (FIB-4, NFS, and APRI) vs. Lower liver fibrosis scores / Normal coronary arteries (0% stenosis) and non-obstructive CAD (1-49% stenosis) was evaluated on Coronary artery disease (CAD, defined as >=50% coronary artery stenosis on CCTA) (OR 1.345, 95% CI 1.142-1.583, p=<0.001). Non-invasive liver fibrosis scores (FIB-4 and NFS) were independently associated with CAD in MAFLD patients.
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