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Higher liver fibrosis scores signal significantly increased MACE and poorer survival in MINOCA, particularly in metabolically compromised patients.
A novel study puts the spotlight on an unexpected predictor of heart risk in myocardial infarction and non-obstructive coronary arteries (MINOCA): the liver. Researchers report that liver fibrosis scores (LFS)—simple, non-invasive markers of liver health—can identify those at substantially higher risk of major adverse cardiovascular events (MACE) and death, especially when diabetes mellitus (DM) or pre-DM is present.
The cohort included 406 MINOCA patients (mean age 63.7 years; 211 men), of whom 271 had DM or pre-DM. Liver fibrosis was evaluated using two widely used scores—the fibrosis-4 index (FIB-4) and the nonalcoholic fatty liver disease fibrosis score (NFS). High-risk thresholds were defined as FIB-4 ≥2.67 and NFS ≥0.676.
Among patients with DM/pre-DM, a substantial proportion already showed elevated fibrosis markers, with 38.9% classified as high FIB-4 and 28.3% as high NFS—pointing to a considerable hidden burden of liver disease in this group. Over a 32-month follow-up, the signal became clear! Those with higher liver fibrosis scores experienced more MACE and had poorer survival (log-rank p < 0.05). The relationship wasn’t just incidental—it followed a distinct pattern.
Risk increased steadily with rising FIB-4 (a linear association), while NFS revealed a nonlinear trend, suggesting risk may accelerate beyond certain thresholds. The most striking insight came from subgroup analysis. Elevated FIB-4 (≥2.67) and NFS (≥0.676) independently predicted MACE—but only in those with DM or pre-DM. In those without metabolic dysfunction, these scores did not show significant predictive power.
This finding underscores a crucial interaction: liver fibrosis and glycemic abnormalities together create a high-risk cardiovascular phenotype. Higher liver fibrosis scores also tracked with more severe cardiac injury and dysfunction. Patients with elevated LFS had higher creatine kinase–myocardial band (CK-MB) and cardiac troponin T levels, lower left ventricular ejection fraction (LVEF), and increased N-terminal pro–B-type natriuretic peptide (NT-proBNP)—classic indicators of worse cardiac status.
In other words, liver fibrosis is not just a bystander; it mirrors—and may contribute to—systemic cardiovascular damage. This study reframes how clinicians might approach risk assessment in MINOCA. Instead of focusing solely on the heart, incorporating liver fibrosis scores yields a broader, more integrated view of cardiometabolic health.
Diabetes Research and Clinical Practice
Liver fibrosis scores predict cardiovascular outcomes in myocardial infarction and non-obstructive coronary arteries patients with and without diabetes or prediabetes
Fuad A. Abdu et al.
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