# Clinically Accessible Liver Fibrosis Association with CT Scan Coronary Artery Disease Beyond Other Validated Risk Predictors: The ICAP Experience

## TL;DR

This study finds that liver fibrosis, along with statin use or obesity, can help identify asymptomatic patients with higher-than-expected coronary artery disease risk based on CT scans.

## Contribution

The study introduces liver fibrosis as a novel predictor of unexpected coronary artery disease severity beyond traditional risk factors.

## Key findings

- Liver fibrosis risk (FIB-4 ≥ 1.3) interacts with statin use and obesity to predict cardiovascular risk excess in asymptomatic patients.
- Models including FIB-4, age, sex, and interactions showed strong discrimination for cardiovascular risk excess in low-to-moderate and high-risk groups.
- CVR excess was observed in 18% of low-to-moderate-risk patients and 15% of high-risk patients.

## Abstract

Background/objectives: Cardiovascular risk (CVR) stratification in clinical settings remains limited. This study aims to evaluate clinical parameters that could improve the identification of higher-than-expected coronary artery disease (CAD) in CT scan coronarography. Methods: In a cross-sectional study of asymptomatic patients from the Integrated Cardiovascular Assessment Program (ICAP), volunteers aged 40–80 without diagnosed cardiovascular disease were assessed. CVR factors like obesity, lipid and glucose profiles, liver fibrosis risk (FIB-4 ≥ 1.3), C-reactive protein, and family history of CVD were evaluated. Patients were stratified by CVR following ESC guidelines. “CVR excess” was defined as CAD-RADS ≥ 2 in low-to-moderate-risk (LMR), CAD-RADS ≥ 3 in high-risk (HR), and CAD-RADS ≥ 4 in very-high-risk (VHR) groups. Results: Among 219 patients (mean age 57.9 ± 1.15 years, 14% female), 43.4% were classified as LMR, 49.3% as HR, and 7.3% as VHR. “CVR excess” was observed in 18% of LMR, 15% of HR, and 19% of VHR patients. LMR patients with prior statin use and HR patients with obesity were more likely to have “CVR excess” (p < 0.01 and p < 0.05, respectively). FIB-4 modified the effect of statin use and obesity on “CVR excess” prediction (p for interactions < 0.05). Models including age, sex, and both interactions showed a strong discrimination for “CVR excess” in LMR and HR groups (AUROC 0.84 (95% CI 0.73–0.95) and 0.82 (95% CI 0.70–0.93), respectively). Conclusions: Suspected liver fibrosis combined with statin use in LMR patients and obesity in HR patients is associated with CVR excess, providing potential indications for image CAD assessment in asymptomatic patients.