Higher fibrosis-4 index is associated with 2-year cardiovascular events in Vietnamese adults with type 2 diabetes mellitus: a prospective cohort study.
- 1Internal Medicine Department, Pham Ngoc Thach University of Medicine, Ho Chi Minh, Vietnam.
- 2Nhan Dan Gia Dinh Hospital, Ho Chi Minh, Vietnam.
Abstract
Background
Cardiovascular disease is a major extrahepatic outcome in type 2 diabetes mellitus (T2DM) and metabolic fatty liver disease, but prospective data integrating transient elastography and the fibrosis-4 index (FIB-4) with observed cardiovascular events remain limited in Southeast Asia.Methods
We conducted a prospective cohort study of adults with T2DM consecutively recruited at a Vietnamese tertiary hospital from June 2023 through January 2025 and followed for up to 24 months. Hepatic steatosis and liver stiffness were assessed by FibroScan©, and metabolic dysfunction-associated fatty liver disease (MAFLD) was defined using the Asian Pacific Association for the Study of the Liver framework. Expanded major adverse cardiovascular events (MACE) were the principal time-to-event outcome. Sparse-event associations were estimated with Firth-penalized Cox regression.Results
Of 452 patients screened, 301 consented and 284 entered the baseline cohort; 280 contributed follow-up. At baseline, MAFLD was present in 72.5% and significant liver fibrosis (liver stiffness measurement ≥7.0 kPa) in 23.9%. During 544.92 person-years, 11 expanded MACE and 5 conventional MACE occurred, corresponding to incidence rates of 20.19 (95% CI 10.08-36.12) and 9.18 (95% CI 2.98-21.41) per 1,000 person-years. In the main Firth model adjusted for age and MAFLD, each increase of 1 interquartile range (IQR; 0.696 units) in FIB-4 was associated with expanded MACE (adjusted hazard ratio 1.56, 95% CI 1.09-1.99; p = 0.022), whereas MAFLD was not statistically significant (adjusted hazard ratio 3.51, 95% CI 0.79-33.09; p = 0.105); the point estimate was above unity but imprecise because of the limited number of events.Conclusion
Higher FIB-4 was associated with short-term cardiovascular events in adults with T2DM. Given the small number of events, these findings require confirmation in larger multicenter cohorts.
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BibTeX
@article{vu2026higher,
title = {{Higher fibrosis-4 index is associated with 2-year cardiovascular events in Vietnamese adults with type 2 diabetes mellitus: a prospective cohort study.}},
author = {Quoc Bao Vu and Hong Minh Cong Vo and Xuan Linh Tran and Tuan Vu Nguyen and Thi Khanh Tuong Tran},
journal = {Frontiers in gastroenterology (Lausanne, Switzerland)},
year = {2026},
month = oct,
doi = {10.3389/fgstr.2026.1973311},
url = {https://europepmc.org/article/MED/42908838},
note = {CC BY},
}
RIS
TY - JOUR
TI - Higher fibrosis-4 index is associated with 2-year cardiovascular events in Vietnamese adults with type 2 diabetes mellitus: a prospective cohort study.
AU - Quoc Bao Vu
AU - Hong Minh Cong Vo
AU - Xuan Linh Tran
AU - Tuan Vu Nguyen
AU - Thi Khanh Tuong Tran
PY - 2026
DA - 2026/10/07
JO - Frontiers in gastroenterology (Lausanne, Switzerland)
DO - 10.3389/fgstr.2026.1973311
UR - https://europepmc.org/article/MED/42908838
AB - Background Cardiovascular disease is a major extrahepatic outcome in type 2 diabetes mellitus (T2DM) and metabolic fatty liver disease, but prospective data integrating transient elastography and the fibrosis-4 index (FIB-4) with observed cardiovascular events remain limited in Southeast Asia.Methods We conducted a prospective cohort study of adults with T2DM consecutively recruited at a Vietnamese tertiary hospital from June 2023 through January 2025 and followed for up to 24 months. Hepatic steatosis and liver stiffness were assessed by FibroScan©, and metabolic dysfunction-associated fatty liver disease (MAFLD) was defined using the Asian Pacific Association for the Study of the Liver framework. Expanded major adverse cardiovascular events (MACE) were the principal time-to-event outcome. Sparse-event associations were estimated with Firth-penalized Cox regression.Results Of 452 patients screened, 301 consented and 284 entered the baseline cohort; 280 contributed follow-up. At baseline, MAFLD was present in 72.5% and significant liver fibrosis (liver stiffness measurement ≥7.0 kPa) in 23.9%. During 544.92 person-years, 11 expanded MACE and 5 conventional MACE occurred, corresponding to incidence rates of 20.19 (95% CI 10.08-36.12) and 9.18 (95% CI 2.98-21.41) per 1,000 person-years. In the main Firth model adjusted for age and MAFLD, each increase of 1 interquartile range (IQR; 0.696 units) in FIB-4 was associated with expanded MACE (adjusted hazard ratio 1.56, 95% CI 1.09-1.99; p = 0.022), whereas MAFLD was not statistically significant (adjusted hazard ratio 3.51, 95% CI 0.79-33.09; p = 0.105); the point estimate was above unity but imprecise because of the limited number of events.Conclusion Higher FIB-4 was associated with short-term cardiovascular events in adults with T2DM. Given the small number of events, these findings require confirmation in larger multicenter cohorts.
SN - 2813-1169
ER -