Moderate, advanced fibrosis linked with risk for congestive heart failure
Data from the Veterans Aging Cohort Study showed an association between higher FIB-4 scores and increased risk for congestive heart failure, including patients with moderate liver fibrosis.
“While clinicians are very familiar with traditional CHF risk factors such as diabetes, understanding that even moderate liver fibrosis may independently contribute to the increased risk of heart failure may be important for reducing the risk of heart failure events,” Kaku A. So-Armah, PhD, from the Boston University School of Medicine, and colleagues wrote. “The fact that vulnerable populations, like those infected with HIV, hepatitis C, or both, already have an increased risk of cardiovascular disease events, makes assessing liver health a potentially important part of any cardiovascular disease risk reduction strategy in these groups.”
The study comprised 96,373 veteran patients with or without HIV. Researchers enrolled patients on or after Apr. 1, 2003, and followed them until incident of congestive heart failure, death or Dec. 31, 2011. Median follow-up was 6.9 years (range, 3.2-8.6 years). Researchers excluded from the study patients with cardiovascular disease at the time of enrollment.
Degree of fibrosis was categorized as minimal fibrosis (n = 57,309), moderate fibrosis (n = 16,360) and advanced fibrosis or cirrhosis (n = 3,679).
There were 3,844 events of congestive heart failure during follow-up. The risk for congestive heart failure was higher in patients with moderate fibrosis (HR = 1.78; 95% CI, 1.65-1.92) and advanced fibrosis or cirrhosis (HR = 2.77; 95% CI, 2.38-3.22), compared with patients with minimal fibrosis.
After adjustment for Framingham cardiovascular disease risk factors, antecedent incident acute myocardial infarction, HIV or HCV status, substance use, and obesity, there was a 17% increased risk for congestive heart failure in patients with moderate fibrosis (HR = 1.17; 95% CI, 1.07-1.27) and for advanced fibrosis or cirrhosis, it was 65% (HR = 1.65; 95% CI, 1.43-1.92).
Compared with patients with minimal fibrosis as baseline, HIV or HCV status was associated with congestive heart failure among patients with moderate fibrosis without infection (HR = 1.08; 95% CI, 0.96-1.22) and with infection (HR = 1.15; 95% CI, 0.93-1.41). The researchers found a similar association in patients with advanced fibrosis without infection (HR = 1.56; 1.19-2.05) and with infection (HR = 1.66; 95% CI, 1.3-2.12).
“The mechanisms driving the association between FIB-4 and incident CHF are understudied, particularly in relation to intermediate levels of liver fibrosis. Earlier work reports an association between cirrhosis and hyperdynamic circulation, electrophysiologic abnormalities and systolic and diastolic dysfunction that culminate in cirrhotic cardiomyopathy,” the researchers wrote. “It may be that similar hemodynamic and electrophysiologic alterations are occurring, albeit to a lesser extent in those who have not yet progressed to cirrhosis, and contributing over time to increased risk of clinical CHF.” – by Talitha Bennett
Disclosure: So-Armah reports no relevant financial disclosures. Please see the full study for the other researchers’ relevant financial disclosures.