# Triglyceride–glucose index and FIB-4 score in relation to cardiovascular disease risk among people with HIV: a retrospective cohort study

## TL;DR

This study shows that people with HIV who have signs of liver fat and insulin resistance are at higher risk for heart and blood vessel diseases, suggesting these factors should be considered in assessing cardiovascular risk.

## Contribution

The study introduces a novel approach by combining hepatic steatosis/insulin resistance and liver fibrosis risk to better predict cardiovascular events in people with HIV.

## Key findings

- The incidence of cardiovascular events was 3.5 per 1,000 person-years in people with HIV.
- Individuals with both high hepatic steatosis/insulin resistance and liver fibrosis risk had 10.6 CVEs per 1,000 person-years, significantly higher than those with normal values.
- Abnormal HS-IR and fibrosis risk scores were independently linked to cardiovascular events even after adjusting for traditional risk factors.

## Abstract

People with HIV (PWH) have a high risk of cardiovascular events (CVEs). We investigated the incidence of CVEs in PWH and the usefulness of combining hepatic steatosis/insulin resistance (HS-IR) and risk of liver fibrosis for the evaluation of cardiovascular risk in PWH.

We retrospectively analyzed 7,286 PWH from the prospective CoRIS cohort. We calculated the baseline triglyceride-glucose index (TyG) and FIB-4 index to assess HS-IR and risk of fibrosis, respectively, and evaluated persons with abnormal values for both indices. The primary outcome was the incidence of CVEs, defined as myocardial infarction, coronary disease, stroke, transient ischemic attack, peripheral arterial obstruction, and/or cardiovascular death. The association between HS-IR and risk of fibrosis and incidence of CVEs was assessed using a univariable and multivariable competing risk survival regression analysis.

The overall incidence of CVEs was 3.5 per 1,000 person-years. HS-IR and risk of fibrosis were significantly associated with an increased risk of CVEs. Individuals with HS-IR and risk of fibrosis experienced markedly more CVEs than those with normal values (10.6 vs. 1.4 per 1,000 person-years, p < 0.001). After correction for possible confounders and traditional cardiovascular risk factors, abnormal values for HS-IR and risk of fibrosis score were independently associated with CVEs of (HR, 2.21 [1.2–4.1]; p < 0.01).

HS-IR and risk of fibrosis before ART are associated with increased risk of CVEs in PWH. A combined risk assessment incorporating HS-IR and risk of fibrosis may improve cardiovascular risk stratification in this population. These readily accessible tools can facilitate early identification and intervention in high-risk individuals.