A NEW study based on ISCHEMIA trial data has revealed that subclinical liver fibrosis, even without overt liver disease, may significantly impact outcomes in patients with coronary artery disease (CAD). Researchers used the fibrosis‐4 (FIB‐4) index, a simple, noninvasive score based on age, platelet count, and liver enzyme levels, to assess liver fibrosis in patients undergoing cardiac treatment.
Traditionally, risk scores for cardiac interventions, such as the EuroScore and the Society of Thoracic Surgeons score, only account for advanced liver cirrhosis. However, findings from this large cohort study suggest that even milder, previously undetected liver fibrosis is linked to a higher risk of death, both all-cause and cardiovascular-related, in patients with CAD.
This connection appears to stem from the role liver fibrosis plays in promoting systemic inflammation, endothelial dysfunction, and coagulation abnormalities, all of which can adversely affect cardiovascular health. Interestingly, these risks remained elevated even after adjusting for age and other clinical factors, suggesting that the FIB‐4 score reflects more than just age-related risk.
Supporting data also show a link between higher FIB‐4 scores and coronary microvascular dysfunction, as well as increased carotid artery thickness, both signs of subclinical atherosclerosis. This indicates a shared pathophysiology between liver fibrosis and cardiovascular disease, with chronic inflammation likely playing a central role.
Although FIB‐4 was originally designed for use in patients with hepatitis or HIV, this study reinforces its utility in broader clinical settings. The findings suggest that incorporating FIB‐4 into cardiovascular risk assessments could help identify patients at higher risk who may benefit from closer monitoring or targeted treatment.
In conclusion, recognising subclinical liver fibrosis as a cardiovascular risk factor could enhance patient care. Further research is needed to confirm whether treating liver fibrosis can improve heart outcomes, but the FIB‐4 score may already be a valuable tool in guiding treatment strategies for patients with CAD.
Reference
Caldonazo T et al. Association of subclinical liver fibrosis with death in patients with coronary artery disease: a post hoc analysis of the ISCHEMIA trial. J Am Heart Assoc. 2025;14(13):e040848.
