The fibrosis-4 index and its association with carotid atherosclerosis in type 2 diabetes: a cross-sectional study in China
Abstract Background The medical community has long been concerned about the cardiovascular disease risk in patients with type 2 diabetes. While liver fibrosis scores were originally designed for application in individuals with liver steatosis, an increasing number of studies have shown that they are...
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2025-01-01
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| Series: | BMC Cardiovascular Disorders |
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| Online Access: | https://doi.org/10.1186/s12872-025-04491-4 |
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| author | Ying Miao Yu Wang Qin Wan Nanwei Tong |
| author_facet | Ying Miao Yu Wang Qin Wan Nanwei Tong |
| author_sort | Ying Miao |
| collection | DOAJ |
| description | Abstract Background The medical community has long been concerned about the cardiovascular disease risk in patients with type 2 diabetes. While liver fibrosis scores were originally designed for application in individuals with liver steatosis, an increasing number of studies have shown that they are also associated with cardiovascular disease risk. However, the association between Fibrosis-4 (Fib-4) in liver fibrosis scores and carotid atherosclerosis (CA) in patients with type 2 diabetes remains unclear. Objective The aim of this study is to investigate the association between the Fib-4 index and CA in patients with Type 2 diabetes. Additionally, it seeks to determine whether this relationship is influenced by factors including gender, age, body mass index (BMI), hypertension, and other variables. Methods Screening based on inclusion and exclusion criteria identified 2658 hospitalized patients with type 2 diabetes. Subsequently, patients were divided into three groups according to Fib-4 values (Fib-4 < 1.3, 1.3 ≤ Fib-4 < 2.67, Fib-4 ≥ 2.67). Logistic regression analysis was then applied to evaluate the association between Fib-4 and the presence of CA in type 2 diabetes. Further stratified analyses were conducted considering gender, age (using 60 years as the threshold), hypertension status, smoking, alcohol consumption, and BMI groups (using 24 kg/m2 as the threshold), aiming to investigate potential effect heterogeneity within predefined subgroups. ROC curve analysis was used to evaluate the predictive power of the Fib-4 value for CA, increased CIMT, and carotid plaques. Results The study encompassed 2658 patients diagnosed with type 2 diabetes, comprising 1441 males and 1217 females, with an average age of 56.71 ± 10.22 years. Among them, 1736 individuals (65.3%) exhibited CA, 1243 (46.8%) had increased carotid intima-media thickness (CIMT), and 1273 (47.9%) manifested carotid plaques. Following adjustments for various factors, the prevalence of CA exhibited a progressive increase in the Fib-4 < 1.3, 1.3 ≤ Fib-4 < 2.67, and Fib-4 ≥ 2.67 groups, with statistically significant differences (P < 0.05). Moreover, the prevalence of increased CIMT and carotid plaques in the Fib-4 ≥ 2.67 group remained significantly higher than that in the Fib-4 < 1.3 group after considering various factors (P < 0.05). In the 1.3 ≤ Fib-4 < 2.67 group, subsequent to adjustments for gender, smoking, and drinking, the prevalence of increased CIMT and carotid plaques surpassed that in the Fib-4 < 1.3 group (P < 0.05). Despite further adjustments for multiple factors, the prevalence of increased CIMT and carotid plaques persisted higher than that in the Fib-4 < 1.3 group, yet the difference lacked statistical significance (P > 0.05). The results of the ROC curve analysis indicated that the AUC for Fib-4 predicting CA was 0.602 (P < 0.001, 95% CI: 0.579–0.625), while the AUC values for increased CIMT and carotid plaques were 0.561 (P < 0.001, 95% CI: 0.540–0.583) and 0.580 (P < 0.001, 95% CI: 0.558–0.601), respectively. Conclusion Elevated Fib-4 levels (Fib-4 ≥ 1.3) are positively associated with CA in patients with type 2 diabetes, including increased CIMT and the presence of carotid plaques. As such, Fib-4 may serve as a potential biomarker for the detection of CA in patients with type 2 diabetes. However, its clinical utility needs further validation, particularly in larger sample sizes and multicenter studies. |
| format | Article |
| id | doaj-art-f6bc0f9a2fc74e68970e916eca441e51 |
| institution | Kabale University |
| issn | 1471-2261 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Cardiovascular Disorders |
| spelling | doaj-art-f6bc0f9a2fc74e68970e916eca441e512025-01-26T12:14:16ZengBMCBMC Cardiovascular Disorders1471-22612025-01-0125111210.1186/s12872-025-04491-4The fibrosis-4 index and its association with carotid atherosclerosis in type 2 diabetes: a cross-sectional study in ChinaYing Miao0Yu Wang1Qin Wan2Nanwei Tong3Department of Endocrinology and Metabolism, Center for Diabetes and Metabolism Research, West China Hospital, Sichuan UniversityDepartment of Cardiology, Luzhou People’s HospitalDepartment of Endocrinology and Metabolism, Affiliated Hospital of Southwest Medical UniversityDepartment of Endocrinology and Metabolism, Center for Diabetes and Metabolism Research, West China Hospital, Sichuan UniversityAbstract Background The medical community has long been concerned about the cardiovascular disease risk in patients with type 2 diabetes. While liver fibrosis scores were originally designed for application in individuals with liver steatosis, an increasing number of studies have shown that they are also associated with cardiovascular disease risk. However, the association between Fibrosis-4 (Fib-4) in liver fibrosis scores and carotid atherosclerosis (CA) in patients with type 2 diabetes remains unclear. Objective The aim of this study is to investigate the association between the Fib-4 index and CA in patients with Type 2 diabetes. Additionally, it seeks to determine whether this relationship is influenced by factors including gender, age, body mass index (BMI), hypertension, and other variables. Methods Screening based on inclusion and exclusion criteria identified 2658 hospitalized patients with type 2 diabetes. Subsequently, patients were divided into three groups according to Fib-4 values (Fib-4 < 1.3, 1.3 ≤ Fib-4 < 2.67, Fib-4 ≥ 2.67). Logistic regression analysis was then applied to evaluate the association between Fib-4 and the presence of CA in type 2 diabetes. Further stratified analyses were conducted considering gender, age (using 60 years as the threshold), hypertension status, smoking, alcohol consumption, and BMI groups (using 24 kg/m2 as the threshold), aiming to investigate potential effect heterogeneity within predefined subgroups. ROC curve analysis was used to evaluate the predictive power of the Fib-4 value for CA, increased CIMT, and carotid plaques. Results The study encompassed 2658 patients diagnosed with type 2 diabetes, comprising 1441 males and 1217 females, with an average age of 56.71 ± 10.22 years. Among them, 1736 individuals (65.3%) exhibited CA, 1243 (46.8%) had increased carotid intima-media thickness (CIMT), and 1273 (47.9%) manifested carotid plaques. Following adjustments for various factors, the prevalence of CA exhibited a progressive increase in the Fib-4 < 1.3, 1.3 ≤ Fib-4 < 2.67, and Fib-4 ≥ 2.67 groups, with statistically significant differences (P < 0.05). Moreover, the prevalence of increased CIMT and carotid plaques in the Fib-4 ≥ 2.67 group remained significantly higher than that in the Fib-4 < 1.3 group after considering various factors (P < 0.05). In the 1.3 ≤ Fib-4 < 2.67 group, subsequent to adjustments for gender, smoking, and drinking, the prevalence of increased CIMT and carotid plaques surpassed that in the Fib-4 < 1.3 group (P < 0.05). Despite further adjustments for multiple factors, the prevalence of increased CIMT and carotid plaques persisted higher than that in the Fib-4 < 1.3 group, yet the difference lacked statistical significance (P > 0.05). The results of the ROC curve analysis indicated that the AUC for Fib-4 predicting CA was 0.602 (P < 0.001, 95% CI: 0.579–0.625), while the AUC values for increased CIMT and carotid plaques were 0.561 (P < 0.001, 95% CI: 0.540–0.583) and 0.580 (P < 0.001, 95% CI: 0.558–0.601), respectively. Conclusion Elevated Fib-4 levels (Fib-4 ≥ 1.3) are positively associated with CA in patients with type 2 diabetes, including increased CIMT and the presence of carotid plaques. As such, Fib-4 may serve as a potential biomarker for the detection of CA in patients with type 2 diabetes. However, its clinical utility needs further validation, particularly in larger sample sizes and multicenter studies.https://doi.org/10.1186/s12872-025-04491-4Fibrosis-4Type 2 diabetesCarotid atherosclerosisMetabolic dysfunction-associated steatotic liver diseaseLiver fibrosis |
| spellingShingle | Ying Miao Yu Wang Qin Wan Nanwei Tong The fibrosis-4 index and its association with carotid atherosclerosis in type 2 diabetes: a cross-sectional study in China BMC Cardiovascular Disorders Fibrosis-4 Type 2 diabetes Carotid atherosclerosis Metabolic dysfunction-associated steatotic liver disease Liver fibrosis |
| title | The fibrosis-4 index and its association with carotid atherosclerosis in type 2 diabetes: a cross-sectional study in China |
| title_full | The fibrosis-4 index and its association with carotid atherosclerosis in type 2 diabetes: a cross-sectional study in China |
| title_fullStr | The fibrosis-4 index and its association with carotid atherosclerosis in type 2 diabetes: a cross-sectional study in China |
| title_full_unstemmed | The fibrosis-4 index and its association with carotid atherosclerosis in type 2 diabetes: a cross-sectional study in China |
| title_short | The fibrosis-4 index and its association with carotid atherosclerosis in type 2 diabetes: a cross-sectional study in China |
| title_sort | fibrosis 4 index and its association with carotid atherosclerosis in type 2 diabetes a cross sectional study in china |
| topic | Fibrosis-4 Type 2 diabetes Carotid atherosclerosis Metabolic dysfunction-associated steatotic liver disease Liver fibrosis |
| url | https://doi.org/10.1186/s12872-025-04491-4 |
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