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Hepatology. 2017 Oct;66(4):1286-1295. doi: 10.1002/hep.29285. Epub 2017 Aug 30.

FIB-4 stage of liver fibrosis predicts incident heart failure among HIV-infected and uninfected patients.

Author information

1
Boston University School of Medicine, Boston, MA.
2
Yale University School of Medicine, New Haven, CT.
3
Philadelphia VA Medical Center, University of Pennsylvania School of Medicine, Philadelphia, PA.
4
VA Connecticut Healthcare System, West Haven, CT.
5
University of Pittsburgh Schools of Medicine and Public Health, Pittsburgh, PA.
6
Weill Cornell Medical College, NY.
7
VA Pittsburgh Healthcare System, PA.
8
Hamad Healthcare Quality Institute, Hamad Medical Corporation, Doha, Qatar.
9
VA Medical Center, Washington, DC.
10
George Washington University School of Medicine and Public Health, Washington, DC.
11
Atlanta VA Medical Center, Atlanta, GA.
12
Emory University School of Medicine, Atlanta, GA.
13
Rollins School of Public Health, Atlanta, GA.
14
VA Greater Los Angeles Healthcare System, Los Angeles, CA.
15
David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA.
16
Michael E. DeBakey VA Medical Center, Houston, TX.
17
Baylor College of Medicine, Houston, TX.
18
Harbor-UCLA Medical Center, Los Angeles, CA.
19
Los Angeles Biomedical Research Institute, Los Angeles, CA.
20
Vanderbilt University School of Medicine, Nashville, TN.
21
Boston University School of Public Health, Boston, MA.
22
Boston Medical Center, Boston, MA.
23
Yale University School of Public Health, New Haven, CT.
24
Nashville Veterans Affairs Medical Center, Nashville, TN.
25
Tennessee Valley Healthcare System, Nashville, TN.

Abstract

Liver fibrosis is common, particularly in individuals who are infected with human immunodeficiency virus (HIV). HIV-infected individuals have excess congestive heart failure (CHF) risk compared with uninfected people. It remains unknown whether liver fibrosis stage influences the CHF risk or if HIV or hepatitis C virus (HCV) infection modifies this association. Our objectives were to assess whether 1) stage of liver fibrosis is independently associated with incident CHF and 2) the association between stage of liver fibrosis and incident CHF is modified by HIV/HCV status. Participants alive on or after April 1, 2003, in the Veterans Aging Cohort Study were included. Those without prevalent cardiovascular disease were followed until their first CHF event, death, last follow-up date, or December 31, 2011. Liver fibrosis was measured using the fibrosis 4 index (FIB-4), which is calculated using age, aminotransferases, and platelets. Cox proportional hazards regression models were adjusted for cardiovascular disease risk factors. Among 96,373 participants over 6.9 years, 3844 incident CHF events occurred. FIB-4 between 1.45 and 3.25 (moderate fibrosis) and FIB-4 > 3.25 (advanced fibrosis/cirrhosis) were associated with CHF (hazard ratio [95% confidence interval], 1.17 [1.07-1.27] and 1.65 [1.43-1.92], respectively). The association of advanced fibrosis/cirrhosis and incident CHF persisted regardless of HIV/HCV status.

CONCLUSION:

Moderate and advanced liver fibrosis/cirrhosis are associated with an increased risk of CHF. The association for advanced fibrosis/cirrhosis persists even among participants without hepatitis C and/or HIV infection. Assessing liver health may be important for reducing the risk of future CHF events, particularly among HIV and hepatitis C infected people among whom cardiovascular disease risk is elevated and liver disease is common. (Hepatology 2017;66:1286-1295).

PMID:
28543215
PMCID:
PMC5609079
DOI:
10.1002/hep.29285
[Indexed for MEDLINE]
Free PMC Article

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