Association of estimated liver fibrosis with carotid but not femoral atherosclerotic burden: the ILERVAS cohort

Introduction: Advanced liver fibrosis, a key complication of metabolic dysfunction-associated steatotic liver disease, has been increasingly linked to extrahepatic conditions, including type 2 diabetes, obesity, and cardiovascular disease. However, the specific association of liver fibrosis in the d...

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Autores: León-Mengíbar, J, Malagón, MM, Bermúdez-López, M, Valdivielso, JM, Pamplona, R, Torres, G, Mauricio, D, Castro, E, Fernández, E, Caixàs, A, Hernández, M, Lopez-Cano, C, Gordon, A, Guzman-Ruiz, R, Cusi, K, Lecube, A
Tipo de recurso: artículo
Estado:Versión publicada
Fecha de publicación:2026
País:España
Institución:Institut d’Investigació Biomèdica Sant Pau (IIB Sant Pau)
Repositorio:r-IIB SANT PAU. Repositorio Institucional de Producción Científica del Instituto de Investigación Biomédica Sant Pau
OAI Identifier:oai:iibsantpau.fundanetsuite.com:p21178
Acceso en línea:https://iibsantpau.fundanetsuite.com/Publicaciones/ProdCientif/PublicacionFrw.aspx?id=21178
Access Level:acceso abierto
Palabra clave:cardiovascular risk factors (CVRF)
FIB-4 index
liver fibrosis
MASLD
metabolic dysfunction associated steatotic liver disease
NAFLD fibrosis score (NFS)
subclinical atheromatous disease
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spelling Association of estimated liver fibrosis with carotid but not femoral atherosclerotic burden: the ILERVAS cohortLeón-Mengíbar, JMalagón, MMBermúdez-López, MValdivielso, JMPamplona, RTorres, GMauricio, DCastro, EFernández, ECaixàs, AHernández, MLopez-Cano, CGordon, AGuzman-Ruiz, RCusi, KLecube, Acardiovascular risk factors (CVRF)FIB-4 indexliver fibrosisMASLDmetabolic dysfunction associated steatotic liver diseaseNAFLD fibrosis score (NFS)subclinical atheromatous diseaseIntroduction: Advanced liver fibrosis, a key complication of metabolic dysfunction-associated steatotic liver disease, has been increasingly linked to extrahepatic conditions, including type 2 diabetes, obesity, and cardiovascular disease. However, the specific association of liver fibrosis in the development and progression of subclinical atheromatous disease across vascular territories remains poorly understood. This study evaluates the utility of two non-invasive indices to predict liver fibrosis and their associations with subclinical atheromatous plaque burden and distribution. Methods: Atheromatous plaque burden (plaque presence, number, and total area) was assessed in the carotid and femoral territories via ultrasonography in 3,981 middle-aged participants without known cardiovascular disease, diabetes, or liver disease from the ILERVAS cohort (ClinicalTrials.gov Identifier: NCT03228459). The fibrosis-4 (FIB-4) and the NAFLD Fibrosis Score (NFS) were evaluated. FIB-4 risk categories were defined as low (<1.30), intermediate (1.30-2.67), and high (>2.67). Results: Participants in the intermediate and high-risk FIB-4 categories exhibited a higher prevalence of carotid atheromatous disease (56.8% vs. 49.5%, p<0.001), a greater number of plaques (p<0.001), and a larger total plaque area (p=0.007). Multivariable analyses confirmed FIB-4 as an independent predictor of carotid plaque burden (OR: 1.14, 95% CI 1.05-1.24, p=0.003), even adjusting for traditional cardiovascular risk factors. Moving from low to high FIB-4 cut-offs was associated with 12.6% higher odds of carotid atherosclerosis. NFS was also independently associated with carotid atheromatosis (OR 1.10, 95% CI 1.05-1.15, p<0.001). No significant associations were found in the femoral territory for either index. Conclusions: Estimated liver fibrosis, particularly FIB-4, is a valuable marker for identifying carotid subclinical atherosclerosis in populations without known liver disease. These findings highlight the importance of vascular territory-specific evaluations and support their utility in integrated liver and cardiovascular risk assessment strategies.FRONTIERS MEDIA SA2026info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersionhttps://iibsantpau.fundanetsuite.com/Publicaciones/ProdCientif/PublicacionFrw.aspx?id=21178Frontiers in EndocrinologyISSN: 16642392reponame:r-IIB SANT PAU. Repositorio Institucional de Producción Científica del Instituto de Investigación Biomédica Sant Pauinstname:Institut d’Investigació Biomèdica Sant Pau (IIB Sant Pau)Inglésinfo:eu-repo/semantics/openAccessoai:iibsantpau.fundanetsuite.com:p211782026-06-14T12:41:47Z
dc.title.none.fl_str_mv Association of estimated liver fibrosis with carotid but not femoral atherosclerotic burden: the ILERVAS cohort
title Association of estimated liver fibrosis with carotid but not femoral atherosclerotic burden: the ILERVAS cohort
spellingShingle Association of estimated liver fibrosis with carotid but not femoral atherosclerotic burden: the ILERVAS cohort
León-Mengíbar, J
cardiovascular risk factors (CVRF)
FIB-4 index
liver fibrosis
MASLD
metabolic dysfunction associated steatotic liver disease
NAFLD fibrosis score (NFS)
subclinical atheromatous disease
title_short Association of estimated liver fibrosis with carotid but not femoral atherosclerotic burden: the ILERVAS cohort
title_full Association of estimated liver fibrosis with carotid but not femoral atherosclerotic burden: the ILERVAS cohort
title_fullStr Association of estimated liver fibrosis with carotid but not femoral atherosclerotic burden: the ILERVAS cohort
title_full_unstemmed Association of estimated liver fibrosis with carotid but not femoral atherosclerotic burden: the ILERVAS cohort
title_sort Association of estimated liver fibrosis with carotid but not femoral atherosclerotic burden: the ILERVAS cohort
dc.creator.none.fl_str_mv León-Mengíbar, J
Malagón, MM
Bermúdez-López, M
Valdivielso, JM
Pamplona, R
Torres, G
Mauricio, D
Castro, E
Fernández, E
Caixàs, A
Hernández, M
Lopez-Cano, C
Gordon, A
Guzman-Ruiz, R
Cusi, K
Lecube, A
author León-Mengíbar, J
author_facet León-Mengíbar, J
Malagón, MM
Bermúdez-López, M
Valdivielso, JM
Pamplona, R
Torres, G
Mauricio, D
Castro, E
Fernández, E
Caixàs, A
Hernández, M
Lopez-Cano, C
Gordon, A
Guzman-Ruiz, R
Cusi, K
Lecube, A
author_role author
author2 Malagón, MM
Bermúdez-López, M
Valdivielso, JM
Pamplona, R
Torres, G
Mauricio, D
Castro, E
Fernández, E
Caixàs, A
Hernández, M
Lopez-Cano, C
Gordon, A
Guzman-Ruiz, R
Cusi, K
Lecube, A
author2_role author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
dc.subject.none.fl_str_mv cardiovascular risk factors (CVRF)
FIB-4 index
liver fibrosis
MASLD
metabolic dysfunction associated steatotic liver disease
NAFLD fibrosis score (NFS)
subclinical atheromatous disease
topic cardiovascular risk factors (CVRF)
FIB-4 index
liver fibrosis
MASLD
metabolic dysfunction associated steatotic liver disease
NAFLD fibrosis score (NFS)
subclinical atheromatous disease
description Introduction: Advanced liver fibrosis, a key complication of metabolic dysfunction-associated steatotic liver disease, has been increasingly linked to extrahepatic conditions, including type 2 diabetes, obesity, and cardiovascular disease. However, the specific association of liver fibrosis in the development and progression of subclinical atheromatous disease across vascular territories remains poorly understood. This study evaluates the utility of two non-invasive indices to predict liver fibrosis and their associations with subclinical atheromatous plaque burden and distribution. Methods: Atheromatous plaque burden (plaque presence, number, and total area) was assessed in the carotid and femoral territories via ultrasonography in 3,981 middle-aged participants without known cardiovascular disease, diabetes, or liver disease from the ILERVAS cohort (ClinicalTrials.gov Identifier: NCT03228459). The fibrosis-4 (FIB-4) and the NAFLD Fibrosis Score (NFS) were evaluated. FIB-4 risk categories were defined as low (<1.30), intermediate (1.30-2.67), and high (>2.67). Results: Participants in the intermediate and high-risk FIB-4 categories exhibited a higher prevalence of carotid atheromatous disease (56.8% vs. 49.5%, p<0.001), a greater number of plaques (p<0.001), and a larger total plaque area (p=0.007). Multivariable analyses confirmed FIB-4 as an independent predictor of carotid plaque burden (OR: 1.14, 95% CI 1.05-1.24, p=0.003), even adjusting for traditional cardiovascular risk factors. Moving from low to high FIB-4 cut-offs was associated with 12.6% higher odds of carotid atherosclerosis. NFS was also independently associated with carotid atheromatosis (OR 1.10, 95% CI 1.05-1.15, p<0.001). No significant associations were found in the femoral territory for either index. Conclusions: Estimated liver fibrosis, particularly FIB-4, is a valuable marker for identifying carotid subclinical atherosclerosis in populations without known liver disease. These findings highlight the importance of vascular territory-specific evaluations and support their utility in integrated liver and cardiovascular risk assessment strategies.
publishDate 2026
dc.date.none.fl_str_mv 2026
dc.type.none.fl_str_mv info:eu-repo/semantics/article
info:eu-repo/semantics/publishedVersion
format article
status_str publishedVersion
dc.identifier.none.fl_str_mv https://iibsantpau.fundanetsuite.com/Publicaciones/ProdCientif/PublicacionFrw.aspx?id=21178
url https://iibsantpau.fundanetsuite.com/Publicaciones/ProdCientif/PublicacionFrw.aspx?id=21178
dc.language.none.fl_str_mv Inglés
language_invalid_str_mv Inglés
dc.rights.none.fl_str_mv info:eu-repo/semantics/openAccess
eu_rights_str_mv openAccess
dc.publisher.none.fl_str_mv FRONTIERS MEDIA SA
publisher.none.fl_str_mv FRONTIERS MEDIA SA
dc.source.none.fl_str_mv Frontiers in Endocrinology
ISSN: 16642392
reponame:r-IIB SANT PAU. Repositorio Institucional de Producción Científica del Instituto de Investigación Biomédica Sant Pau
instname:Institut d’Investigació Biomèdica Sant Pau (IIB Sant Pau)
instname_str Institut d’Investigació Biomèdica Sant Pau (IIB Sant Pau)
reponame_str r-IIB SANT PAU. Repositorio Institucional de Producción Científica del Instituto de Investigación Biomédica Sant Pau
collection r-IIB SANT PAU. Repositorio Institucional de Producción Científica del Instituto de Investigación Biomédica Sant Pau
repository.name.fl_str_mv
repository.mail.fl_str_mv
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