FIB-4 stage of liver fibrosis is associated with incident heart failure with preserved, but not reduced, ejection fraction among people with and without HIV or hepatitis C

• Type of Material: Article
• Authors: Kaku A. So-Armah, Boston University; Joseph K. Lim, Yale University; Vincent Lo Re, University of Pennsylvania; Janet P. Tate, Yale University; Chung-Chou Chang, University of Pittsburgh; Adeel A. Butt, Weill Cornell Medical College; Cynthia L. Gibert, VA Medical Center & George Washington University School of Medicine and Public Health; David Rimland, Emory University; Vincent Marconi, Emory University; Matthew Bidwell Goetz, VA Greater Los Angeles Healthcare System; Vasan Ramachandran, Boston University; Evan Brittain, Vanderbilt University; Michelle Long, Boston University; Kim-Lien Nguyen, University of California Los Angeles; Maria C. Rodriguez-Barradas, Baylor College of Medicine; Matthew J. Budoff, Harbor-UCLA Medical Center and Los Angeles Biomedical Research Institute; Hilary A. Tindle, Vanderbilt University; Jeffrey H. Samet, Boston University; Amy C. Justice, Yale University; Matthew S. Freiberg, Vanderbilt University
• Language: English
• Date: 2020-03-01
• Publisher: W. B. Saunders Co-Elsevier Inc.
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2020 Published by Elsevier Inc.
• License: Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1016/j.pcad.2020.02.010
• Title of Journal or Parent Work: Progress in Cardiovascular Diseases
• Volume: 63
• Issue: 2
• Start Page: 184
• End Page: 191
• Grant/Funding Information: This work was supported by grant K01 HL1314701 and HL095136 from the National Heart, Lung, and Blood Institute and grants AA013566-10, AA020790, and AA020794 from the National Institute on Alcohol Abuse and Alcoholism at the National Institutes of Health.; Dr. Long is supported in part by grant K23 DK113252 from the National Institute of Diabetes and Digestive and Kidney Diseases.
• Keywords: Risk Factors; Markers; Liver fibrosis; Life Sciences & Biomedicine; Science & Technology; Health; Cardiac & Cardiovascular Systems; Adults; Heart failure; Cardiovascular System & Cardiology; Cohort; Ejection fraction; Infection; Hepatitis; HIV
• Research Categories: Health Sciences, Health Care Management; Health Sciences, Medicine and Surgery; Health Sciences, Public Health

Abstract

Background Liver fibrosis, is independently associated with incident heart failure (HF). Investigating the association between liver fibrosis and type of HF, specifically HF with reduced ejection fraction (EF; HFrEF) or HF with preserved ejection fraction (HFpEF), may provide mechanistic insight into this association. We sought to determine the association between liver fibrosis score (FIB-4) and type of HF, and to assess whether HIV or hepatitis C status modified this association. Methods We included patients alive on or after 4/1/2003 from the Veterans Aging Cohort Study. We followed patients without prevalent cardiovascular disease until their first HF event, death, last clinic visit, or 9/30/2015. We defined liver fibrosis as: likely advanced fibrosis (FIB-4 > 3.25), indeterminate (FIB-4 range 1.45–3.25), unlikely advanced fibrosis (FIB-4 < 1.45). Primary outcomes were HFrEF and HFpEF (defined using ICD-9 diagnoses for HF, and EF extracted from electronic medical records using natural language processing). Cox proportional hazards models were adjusted for potential confounders and used to estimate hazard ratios (HR). Results Among 108,708 predominantly male (96%) participants mean age was 49 years. Likely advanced fibrosis was present in 4% at baseline and was associated with an increased risk of HFpEF [HR (95% confidence interval)] [1.70 (1.3–2.3)]; and non-significantly with HFrEF [1.20 (0.9–1.7)]. These associations were not modified by HIV or hepatitis C status. Conclusion Likely advanced fibrosis was independently associated with incident HFpEF but not HFrEF. This suggests that risk factors and/or mechanisms for liver fibrosis may have greater overlap with those for HFpEF than HFrEF.