Background: Metabolic dysfunction-associated steatotic liver disease (MALSD) is a recent classification that better reflects the cardiometabolic factors contributing to the condition, while reducing stigma associated with previous terminology. Characterized by triglyceride accumulation, MALSD can progress to inflammation and fibrosis if untreated. Although the FIB-4 score is commonly used to assess liver fibrosis, its association with cardiovascular outcomes in MALSD patients remains unclear. This study aims to explore the impact of metabolic comorbidities on the risk of coronary artery disease (CAD), congestive heart failure (CHF), and peripheral artery disease (PAD) in patients with low and moderate FIB-4 scores.
Methods: This is a retrospective cross-sectional study. Data about unique ambulatory primary visit between January 2023 and March 2024 were retrieved from the electronic health records (EHR) of Lincoln Medical Center (Bronx, NY) and stratified by FIB-4 score. Patients were divided into two groups based on FIB-4 score: low-risk (FIB-4 < 1.3, n=9,344) and moderate-risk (FIB-4 ≥1.3, n=4,442). Patients with alcohol use disorder or on insulin therapy were excluded. The primary outcome was the occurrence of congestive heart failure (CHF), coronary artery disease (CAD), or peripheral artery disease (PAD). The metabolic comorbidities preliminary analyzed were hypertension, diabetes, hyperlipidemia, and obesity. The odds ratio was obtained by logistic regression.
Results: During the analysis, 122 low-risk patients and 77 moderate-risk patients with identified alcohol use disorder were excluded. Among the low-risk population, 67% were Hispanic/Latinx, 23% were African American, with a mean age of 48.6 years and a mean BMI of 30.0. In the moderate-risk, 68% were Hispanic/Latinx, and 24% were African American, with a mean age of 46 years and a mean BMI of 28.7. In terms of comorbidities, among the low-risk patients, 41% had hypertension (n=3829), 27% had diabetes (n=2499), 40% had hyperlipidemia (n=3759), 24% had obesity (n=2281), and 3% experienced a cardiovascular outcome (n=319). Among the moderate-risk patients, 72% had hypertension (n=2838), 35% had diabetes (n=1364), 59% had hyperlipidemia (n=2330), and 34% had obesity (n=1330). Compared to the low-risk group, the moderate-risk exhibited a higher prevalence of comorbidities and cardiovascular complications.Analysis of comorbidities revealed that hypertension was the highest risk factor for experiencing a cardiovascular outcome in both low-risk (odds ratio [OR] 8.80, 95% confidence interval [CI] 6.50–12.18) and moderate-risk patients (OR 3.52, 95% CI 2.53–5.04). Diabetes was the second highest risk factor for both low-risk (OR 4.73, 95% CI 3.76–5.97) and moderate-risk patients (OR 1.80, 95% CI 1.46–2.23). Hyperlipidemia was identified as the third highest risk factor in the low-risk group (OR 2.98, 95% CI 2.36–3.79), but it was not a significant risk factor for the moderate-risk. Obesity was not found to be a significant risk factor for cardiovascular outcomes in either group.
Conclusions: Hypertension, diabetes and hyperlipidemia are significant risk factors for having worse cardiovascular outcomes in patients with low and moderate FIB-4 scores. This highlights the importance of FIB-4 score as a possible valuable tool in stratifying cardiovascular risk, potentially aiding in the identification of patients at higher risk for developing CAD, CHF, or PAD. Further prospective studies are needed to adjust confounders.