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Canadian Journal of Cardiology

FIB-4 Predicts MACE and Cardiovascular Mortality in Patients With Nonalcoholic Fatty Liver Disease

Published:August 03, 2022DOI:https://doi.org/10.1016/j.cjca.2022.07.016
      Nonalcoholic fatty liver disease (NAFLD) is the leading cause of chronic liver disease globally and is estimated to affect one-third of the global population.
      • Toh J.Z.K.
      • Pan X.H.
      • Tay P.W.L.
      • et al.
      A meta-analysis on the global prevalence, risk factors and screening of coronary heart disease in nonalcoholic fatty liver disease [e-pub ahead of print].
      Cardiovascular disease (CVD) remains the leading cause of mortality for NAFLD because it is closely associated with atherogenic dyslipidemia resulting in the formation of coronary plaques.
      • Toh J.Z.K.
      • Pan X.H.
      • Tay P.W.L.
      • et al.
      A meta-analysis on the global prevalence, risk factors and screening of coronary heart disease in nonalcoholic fatty liver disease [e-pub ahead of print].
      In a recent meta-analysis it was estimated that 44.6% have coronary heart disease and concurrent structural heart changes can also occur resulting in diastolic dysfunction in patients with NAFLD.
      • Toh J.Z.K.
      • Pan X.H.
      • Tay P.W.L.
      • et al.
      A meta-analysis on the global prevalence, risk factors and screening of coronary heart disease in nonalcoholic fatty liver disease [e-pub ahead of print].
      ,
      • Yong J.N.
      • Ng C.H.
      • Lee C.W.
      • et al.
      Non-alcoholic fatty liver disease association with structural heart, systolic and diastolic dysfunction: a meta-analysis.
      Despite the significant cardiac burden in patients with NAFLD, predicting CVD mortality in patients with NAFLD remains challenging. Traditional risk scoring systems including Framingham Heart Score do not account for hepatic fibrosis that has been closely associated with CVD events.
      • Arnett D.K.
      • Blumenthal R.S.
      • Albert M.A.
      • et al.
      2019 ACC/AHA guideline on the primary prevention of cardiovascular disease: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines.
      However, emerging evidence has shown the potential of noninvasive tests (NITs) in predicting outcomes in NAFLD.
      • Tamaki N.
      • Kurosaki M.
      • Huang D.Q.
      • Loomba R.
      Noninvasive assessment of liver fibrosis and its clinical significance in nonalcoholic fatty liver disease.
      Higuchi et al. used magnetic resonance elastography to predict major adverse cardiovascular events (MACE) in patients with NAFLD.
      • Higuchi M.
      • Tamaki N.
      • Kurosaki M.
      • et al.
      Longitudinal association of magnetic resonance elastography-associated liver stiffness with complications and mortality.
      It remains to be seen if serological NITs are effective in predicting CVD disease and mortality. Hence, we sought to examine the applicability of NITs including Fibrosis-4 Index (FIB-4), AST to Platelet Ratio Index (APRI) and NAFLD Fibrosis Score (NFS) to predict CVD events and mortality in NAFLD.
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      References

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        • Pan X.H.
        • Tay P.W.L.
        • et al.
        A meta-analysis on the global prevalence, risk factors and screening of coronary heart disease in nonalcoholic fatty liver disease [e-pub ahead of print].
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        Non-alcoholic fatty liver disease association with structural heart, systolic and diastolic dysfunction: a meta-analysis.
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