Bang Matthew, Fan Wenjun, Wong Nathan D
Heart Disease Prevention Program, Division of Cardiology, University of California, Irvine, USA.
Am Heart J Plus. 2024 Sep 6;46:100457. doi: 10.1016/j.ahjo.2024.100457. eCollection 2024 Oct.
Liver fibrosis is associated with increased cardiovascular disease (CVD) risk and mortality. However, it is unknown how these risks compare in those with pre-diabetes (pre-DM) or diabetes (DM). We examined the association of FIB-4 levels, an indicator of liver fibrosis, with CVD risk and mortality according to DM status.
Prospective, longitudinal cohort study.
We examined 13,326 U.S. adults (6.7 % with DM) with FIB-4 measures classified as low (<1.30), intermediate (1.30- < 2.67), high (2.67- < 3.25), and very high (≥3.25). National Death Index linkage provided mortality status for CVD, liver-related, and all causes over 17.5 years.
We calculated 10-year ASCVD risk in persons without known ASCVD. Cox regression examined the relation of FIB-4 with mortality by DM status.
High/very high FIB-4 levels were greater in those with (2.2 %) vs. without (0.4 %) DM ( < 0.0001). Higher FIB-4 scores and DM were associated with greater estimated ASCVD risks ( < 0.0001); 44.5 % of those at high /very high FIB-4 levels had ≥20 % estimated ASCVD risk. CVD mortality hazard ratios (HRs) (95 % CI) associated with high/very high FIB-4 in those with pre-DM and DM were 8.76 (3.66-20.95), and 0.89 (0.22-3.53), respectively, and for total mortality were 5.46 (3.16-9.43), and 2.07 (0.90-4.74), respectively, which were attenuated after adjustment.
Our findings indicate the need for increased efforts to identify those at risk of liver fibrosis in adults with pre-DM or DM to prevent CVD and total mortality.
肝纤维化与心血管疾病（CVD）风险增加及死亡率升高相关。然而，在糖尿病前期（pre-DM）或糖尿病（DM）患者中，这些风险的比较情况尚不清楚。我们根据糖尿病状态，研究了肝纤维化指标FIB-4水平与CVD风险及死亡率之间的关联。
前瞻性纵向队列研究。
我们对13326名美国成年人（6.7%患有糖尿病）进行了研究，其FIB-4测量值分为低（<1.30）、中（1.30 - <2.67）、高（2.67 - <3.25）和非常高（≥3.25）四类。通过与国家死亡指数链接，获取了17.5年期间CVD、肝脏相关及全因死亡率状态。
我们计算了无已知动脉粥样硬化性心血管疾病（ASCVD）患者的10年ASCVD风险。Cox回归分析了FIB-4与糖尿病状态下死亡率的关系。
患有糖尿病（2.2%）的人群中FIB-4水平高/非常高的比例高于未患糖尿病（0.4%）的人群（P<0.0001）。较高的FIB-4评分和糖尿病与更高的估计ASCVD风险相关（P<0.0001）；FIB-4水平高/非常高的人群中，44.5%的人估计ASCVD风险≥20%。糖尿病前期和糖尿病患者中，FIB-4水平高/非常高与CVD死亡率的风险比（HR）（95%CI）分别为8.76（3.66 - 20.95）和0.89（0.22 - 3.53），全因死亡率的风险比分别为5.46（3.16 - 9.43）和2.07（0.90 - 4.74），调整后有所减弱。
我们的研究结果表明，需要加大力度识别糖尿病前期或糖尿病成年患者中肝纤维化风险人群，以预防CVD和全因死亡率。
