The Fibrosis-4 Index (FIB-4) correlates with cardiovascular risk and insulin resistance in patients with rheumatoid arthritis.

Abstract

OBJECTIVES The Fibrosis-4 index (FIB-4), a non-invasive tool for assessing liver fibrosis, has also been linked to cardiovascular (CV) risk in the general population. This connection is due to the association of chronic liver diseases, particularly fibrosis or non-alcoholic fatty liver disease, with systemic inflammation, metabolic syndrome, and atherosclerosis. In this study, we aimed to calculate the FIB-4 index in patients with rheumatoid arthritis (RA), a condition associated with increased CV disease risk. We then examined its association with disease characteristics and CV comorbidities, including lipid profile, subclinical carotid atherosclerosis, and insulin resistance indices. METHODS A total of 465 RA patients were recruited in this cross-sectional study. They underwent comprehensive evaluations, including disease-related features, complete lipid profile, anthropometric measurements, insulin resistance indices (using HOMA), metabolic syndrome criteria, and carotid ultrasound for intima-media thickness and carotid plaque detection. FIB-4 was calculated and categorized into low (<1.45), indeterminate (1.45-3.25) and high risk (>3.25) for fibrosis. A multivariable linear regression analysis was performed to examine the associations between the disease characteristics and FIB-4. RESULTS Twenty percent of RA patients had a FIB-4 score indicating indeterminate or high risk for hepatic fibrosis. FIB-4 was significantly associated with higher values of the cardiovascular risk calculator SCORE2 but not with carotid atherosclerosis. It was also significantly related to insulin resistance and metabolic syndrome. However, after multivariable analysis, FIB-4 did not correlate with RA disease characteristics, including disease activity. CONCLUSION Up to 20% of RA patients show an abnormal FIB-4 index, which correlates with cardiovascular risk and insulin resistance.