Diabetes Res Clin Pract. 2026 Aug 25:113508. doi: 10.1016/j.diabres.2026.113508. Online ahead of print.
ABSTRACT
BACKGROUND: As a highly prevalent metabolic disorder worldwide, MASLD drives atherosclerotic cardiovascular complications through shared inflammatory and metabolic mechanisms collectively termed the liver-heart axis. Metabolic dysfunction-associated fatty liver disease (MASLD, formerly NAFLD) is closely linked to coronary artery disease (CAD) via the liver-heart axis. The FIB-4 index is an inexpensive, routine laboratory-based non-invasive marker for staging hepatic fibrosis, but its correlative value for CAD severity across clinical subgroup in MASLD remain unclear among patients with angiographically confirmed coronary lesions.
METHODS: This cross-sectional study included 423 patients presenting with chest pain with MASLD who underwent coronary angiography as the diagnostic gold standard for coronary artery disease. CAD severity was graded into 4 ordinal groups by Gensini score to quantify the degree of coronary stenosis. Multivariable ordinal logistic regression, ROC curve, Bootstrap validation, and stratified analyses (sex, age, hypertension, diabetes) were performed to evaluate the graded correlation between FIB-4 and coronary lesion burden.
RESULTS: Following adjustment for major cardiovascular confounders including age, hypertension and diabetes history, FIB-4 showed an independent correlation with CAD severity (OR = 1.445, P = 0.016). In stratified fully adjusted models, a statistically significant association was observed only among hypertensive patients (OR = 1.507, P = 0.022), with non-significant positive trends in men and those < 60 years; however, formal interaction testing did not confirm statistically significant effect modification across any subgroup (all P for interaction > 0.05), indicating that these subgroup differences may reflect chance variation rather than true effect heterogeneity. No meaningful association was found in women, patients ≥ 60 years, normotensive patients, or diabetics. AUC for moderate-to-severe CAD was 0.569, suggesting modest standalone discriminatory ability of FIB-4 alone.
CONCLUSIONS: For clinical cardiovascular risk stratification purposes, FIB-4 showed an independent statistical association with CAD severity in MASLD, with a within-subgroup significant association observed among hypertensive patients, although formal interaction testing did not confirm statistically meaningful effect modification (all P for interaction > 0.05). Caution is warranted when interpreting this subgroup finding given the lack of confirmed effect heterogeneity. This simple, low-cost marker can only serve as an auxiliary indicator to supplement cardiovascular risk stratification alongside conventional risk factors, with weak standalone discriminative power, and it cannot be used as an independent screening tool for all MASLD patients in primary and cardiology clinical practice.
PMID:42641802 | DOI:10.1016/j.diabres.2026.113508