Fibrosis-4 Associated With Arterial Damage, CHD Risk in Patients With T2D

A cross-sectional study found that fibrosis-4 index was linked to arterial damage and risk of coronary heart disease (CHD) in people with type 2 diabetes (T2D).

Coronary heart disease (CHD) and arterial damage were closely associated with the fibrosis-4 (FIB4) index in patients with type 2 diabetes (T2D), according to new study findings published in International Journal of Hypertension. the FIB4 index also dentified those at a higher risk of cardiovascular disease (CVD).

Patients with T2D are at a higher risk of developing CVD. Determining the relationship between hepatic fibrosis and risk of CVD in patients with T2D is important, as fibrosis is often linked to mortality. The FIB4 index is the best indicator of fibrosis in patients with nonalcoholic fatty liver disease (NAFLD) and reflects the risk of fibrosis in patients with T2D.

Participants for this study were patients who were ambulatory and treated at either the Department of Neurology, Hematology, Metabolism, Endocrinology, and Diabetology at the Yamagata University Faculty of Medicine or the Division of Diabetes and Metabolic Disease, Department of Internal Medicine, at Nihon University School of Medicine. Patients were excluded if they had chest and cardiac diseases that affected the evaluation, malignant diseases, collagen diseases, and acute and chronic inflammatory diseases, and required immunosuppressants and steroid hormone therapy.

Carotid intima-media thickness (IMT) was used to evaluate arterial damage, the Suita score of study participants was used to estimate risk of CHD, and aortic arch calcification (AAC) was used in conjunction with IMT to assess CVD risk.

Data on platelet count and biochemical variables including lipid metabolism, uric acid, and hemoglobin A1c (HbA1c) were taken after a fast. Renal function was assessed using estimated glomerular filtration rate (eGFR). Patients with hypertension were considered to be those treated for hypertension or with a blood pressure above 140/90 mm Hg. The FIB4 index was used to evaluate hepatic fibrosis in the study subjects.

There were 253 participants in the study, with 64.4% men and a mean (SD) age of 65.6 (10.9) years. There were 195 patients (77.1%) with hypertension and 147 (58.1%) receiving statins. The mean systolic and diastolic blood pressures were 130.6 (16.8) and 76.4 (11.2) mm Hg, respectively. The participants had a mean eGFR of 74.14 (25.16) mL/min/1.73 m2, and the mean HbA1c was 7.95 (1.88%).

The mean FIB4 index was 1.52 (0.74), and there were 130 (51.4%) patients with no risk of hepatic fibrosis. Diastolic blood pressure (r, –0.189), eGFR (r, –0.243), and HbA1c (r, –0.206) were inversely correlated to FIB4 index.

A positive correlation was found between the FIB4 index and IMT and Suita score (r, 0.241; r, 0.291, respectively). Patients with carotid artery calcification (CAC) had a significantly higher FIB4 index compared with those without (1.70 [0.69] vs 1.24 [0.74]). Patients with AAC grade 1 or 2 had a higher FIB4 index compared with patients who had grade 0; the FIB4 index increased with a higher grade of AAC.

There was a positive association between the FIB4 index and IMT, Suita score, CAC, and AAC grade (b, 0.312; b, 3.573; b, 0.183; b, 0.355, respectively). A linear regression model also found an positive association between the FIB4 index and IMT (b, 0.241), Suita score (b, 2.994), CAC (b, 0.139), and AAC grade (b, 0.265).

There were some limitations to this study. All participants had a FIB4 index calculated, including patients at a low risk of NAFLD or nonalcoholic liver steatohepatitis, although this calculation is only recommended for patients with NAFLD or nonalcoholic liver steatohepatitis. The study also may have included participants who have undiagnosed chronic hepatic disease.

The researchers concluded that assessment of hepatic fibrosis with the FIB4 index was associated with arterial damage and risk of CHD in patients of Japanese ancestry and T2D.


Watanabe K, Takakubo N, Saigusa T, et al. Fibrosis-4 index is closely associated with arterial damage and future risk of coronary heart disease in type 2 diabetes. Int J Hypertens. Published online July 7, 2022. doi:10.1155/2022/2760027

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