Cardiovascular Risk Stratification Using the Framingham Risk Score in Patients with Non-Alcoholic Fatty Liver Disease: A Cross-Sectional Analytical Study Based on FIB-4 Index

Abstract

Objective: To assess the 10-year cardiovascular disease risk using the Framingham Risk Score in patients with Non-alcoholic fatty liver disease (NAFLD) and to compare cardiovascular disease (CVD) risk across disease severity based on FIB-4 index within a non-invasive liver disease assessment (NILDA) framework. Methods: This analytical cross-sectional study was conducted from August 2023 to August 2024. NAFLD was diagnosed using ultrasonography and further stratified using non-invasive indices, including the Fibrosis-4 (FIB-4) index and NAFLD Fibrosis Score (NFS). Cardiovascular risk was assessed using the validated Framingham Risk Score and categorized as low, intermediate, or high risk. Associations between NAFLD severity and CVD risk categories were evaluated using ordinal logistic regression. A p-value <0.05 was considered statistically significant. Results: Among 196 NAFLD patients, 64.3% were male. The mean Framingham CVD risk was 11.14%±7.8. A total of 100 (51.02%) participants were classified as low risk, 62 (31.63%) as intermediate risk, and 34 (17.35%) as high risk. Patients with low-risk of advanced fibrosis (FIB-4<1.3) had significantly lower odds of higher CVD risk compared to those with high-risk fibrosis (FIB-4>2.6) (AOR = 0.06, 95% CI: 0.02–0.17, p < 0.001). Similarly, intermediate-risk patients (FIB-4 1.3–2.6) also demonstrated reduced odds (AOR = 0.13, 95% CI: 0.05–0.37, p < 0.001). Conclusion: Cardiovascular risk in NAFLD patients increases with advancing age and higher FIB-4 scores, indicating that non-invasive fibrosis assessment can serve as an important predictor of cardiovascular risk. Early identification and integrated management strategies are essential to reduce long-term cardiovascular morbidity and mortality.