Abstract 13517: Simple Noninvasive FIB-4 Index is Associated With Increased Risk for Spectrum of Atherosclerotic Cardiovascular Diseases: Insights From the Houston Methodist CVD Learning Health System Registry

Abstract

Introduction: Non-alcoholic fatty liver disease and liver fibrosis (LF) are associated with atherosclerotic cardiovascular disease (ASCVD). In this study, we aim to assess if the Fibrosis-4 index (FIB-4), a surrogate marker for liver fibrosis that is easily calculated from information within electronic medical records, is associated with composite and subgroups of ASCVD across a wide range of demographics and risk profile in a large integrated healthcare system. Methods: This cross-sectional study analyzed data on 606,056 individuals (>18 years old) from the Houston Methodist Cardiovascular Disease Learning Health System Registry (June 2016-April 2022). We implemented the FIB-4 score for patients based on simultaneous presence of 4 variables (age, AST, ALT, and platelet count). LF risk was categorized according to previously described cutoffs: Low (<1.3), Intermediate (1.3-2.67), and High (>2.67). ASCVD (CAD, PAD, and Stroke) were identified using ICD-10-CM codes. Results: In the final study population (mean age: 54 years, 60% females, 16% Non-Hispanic Black, and 16% Hispanic adults), 27% of individuals were at moderate-risk and 8% at high-risk for LF based on the FIB-4 index. Moderate-high risk LF is associated with higher age-adjusted prevalence of both composite and subcategories of ASCVD (CAD, PAD, Stroke). Accounting for demographics, CV risk factors, and ASA/statin use, moderate and high-risk LF was associated with a 1.32 (95% CI 1.30-1.35) and 1.67 (95% CI 1.62-1.72) odds of prevalent composite ASCVD, respectively, compared to low-risk LF. Similar associations were noted for increasing LF risk and prevalence of ASCVD subcategories. Conclusions: In a large integrated health system, a moderate-high risk of liver fibrosis (based on FIB-4 index) is significantly associated with a spectrum of ASCVD conditions. FIB-4 index based early identification and management of these high-risk individuals need to be evaluated in further implementation studies.