Liver fibrosis marker is an independent predictor of cardiovascular morbidity and mortality in the general population

Yochai Schonmann, Hanny Yeshua, Itay Bentov, Shira Zelber-Sagi

Research output: Contribution to journalArticlepeer-review


Background: A growing body of evidence suggests that Non-alcoholic fatty liver disease (NAFLD) and liver fibrosis are associated with cardiovascular disease (CVD). However, the independent role of liver fibrosis markers in the prediction of CVD in the general population is seldom tested. Aims: To assess whether a marker of liver fibrosis predicts the first occurrence of a CVD event in a large sample of community-based general population. Methods: Historical cohort using data from a large health provider that operates a centralized computerized medical record. The level of liver fibrosis was measured by the fibrosis-4 (FIB-4) score, and the association with CVD was adjusted for the European Systematic Coronary Risk Evaluation calculator (SCORE). Results: The study included 8,511 individuals, 3,292 with inconclusive fibrosis and 195 with advanced fibrosis (FIB-4 ≥ 2.67). People with advanced fibrosis had higher risk for CVD, after adjustment for sociodemographic characteristics, the SCORE, use of statins and aspirin (HR [95%CI], 1.63 [1.29–2.06]). The association persisted in both women and men. Using age-specific cut-offs, there was a dose-response association between inconclusive and advanced fibrosis and CVD (HR [95%CI], 1.15 [1.01–1.31]) and HR [95%CI], 1.60 [1.27–2.01], respectively, P for trend<0.001). Conclusions: A simple fibrosis score is independently associated with CVD, suggesting that fibrosis markers should be considered in primary-care risk assessment.

Original languageAmerican English
Pages (from-to)79-85
Number of pages7
JournalDigestive and Liver Disease
Issue number1
StatePublished - Jan 2021


  • Aged
  • Cardiovascular
  • Cardiovascular Diseases/mortality
  • Cohort Studies
  • Disease Progression
  • Female
  • Fibrosis marker
  • Heart Disease Risk Factors
  • Humans
  • Israel/epidemiology
  • Liver Cirrhosis/epidemiology
  • Male
  • Middle Aged
  • Non-alcoholic Fatty Liver Disease/complications
  • Risk prediction
  • Severity of Illness Index

All Science Journal Classification (ASJC) codes

  • Gastroenterology
  • Hepatology


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