Assessment of hepatic fibrosis in MAFLD: A new player in the evaluation of residual cardiovascular risk?

We read with great interest the recently published paper by Shonmann et al. [ [1] Schonmann Y. Hanny Yeshua H. Bentov I. Zelber-Sagi S. Liver fibrosis marker is an independent predictor of cardiovascular morbidity and mortality in the general population. Dig Liv Dis. 2020; 53: 79-85 Abstract Full Text Full Text PDF PubMed Scopus (6) Google Scholar ] reporting on an independent positive association between liver fibrosis and ten-year incidence of cardiovascular events (CVEs) in a large sample of community-based general population in Israel. Fibrosis was non-invasively assessed by the FIB-4 score, a simple and well validated score used to rule out (cut-off value ≤1.3) or rule in (cut-off ≥2.67) significant liver fibrosis (F2-F3) [ [2] Anstee Q.M. Lawitz E.J. Alkhouri N. et al. Noninvasive tests accurately identify advanced fibrosis due to NASH: baseline data from the STELLAR trials. Hepatology. 2019; 70: 1521-1530 Crossref PubMed Scopus (75) Google Scholar , [3] Siddiqui M.S. Yamada G. Vuppalanchi R. et al. Diagnostic accuracy of noninvasive fibrosis models to detect change in fibrosis stage. Clin Gastroenterol Hepatol. 2019; 17: 1877-1885 Abstract Full Text Full Text PDF PubMed Scopus (52) Google Scholar . These results are of considerable interest since they suggest that hepatic fibrosis could therefore be interpreted as an additional non-lipid marker of residual cardiovascular risk, defined as the risk that remains after the optimal multifactorial treatment of all the coexisting risk factors in the individual. Liver fibrosis marker is an independent predictor of cardiovascular morbidity and mortality in the general populationDigestive and Liver DiseaseVol. 53Issue 1PreviewA growing body of evidence suggests that Non-alcoholic fatty liver disease (NAFLD) and liver fibrosis are associated with cardiovascular disease (CVD). However, the independent role of liver fibrosis markers in the prediction of CVD in the general population is seldom tested. Full-Text PDF Reply to: “Assessment of hepatic fibrosis in MAFLD: a new player in the evaluation of residual cardiovascular risk?”Digestive and Liver DiseaseVol. 53Issue 3PreviewWe thank Baratta and colleagues for expressing interest in our manuscript [1]. We read with great interest their findings indicating a role for fibrosis markers in cardiovascular disease (CVD) prediction in a population with ultrasound diagnosed NAFLD. The findings presented by Baratta et al. are in conjunction with our findings and support the important predictive role of liver fibrosis in general health. Taken together these findings emphasize the potential in the embedded use of non-invasive fibrosis markers for primary prevention at several levels of care and different settings. Full-Text PDF