Exploring Liver Fibrosis as a Cardiovascular Risk Marker in Severe Obesity

In a study published in the Journal of Clinical Medicine, higher liver fibrosis estimated by the FIB-4 index correlated with markers of vascular damage and systemic inflammation in patients with severe obesity.

In a cohort of bariatric surgery candidates, investigators used noninvasive fibrosis estimates alongside vascular measures (cIMT, PWV) and found that higher FIB-4 was associated with greater arterial thickening and stiffness after controlling for age, sex, BMI, and traditional cardiometabolic risk factors. These data support FIB-4 as an evidence-based marker that identifies a higher-risk subset among patients with severe obesity.

Fibrosis likely embodies a systemic metabolic and inflammatory burden that links steatotic liver disease, chronic inflammation, and atherogenesis. The study used carotid intima-media thickness and pulse wave velocity as objective vascular endpoints; both capture arterial wall thickening and stiffness and are established predictors of future cardiovascular events. By providing biologically plausible intermediates between hepatic injury and downstream cardiovascular morbidity, these measures strengthen the case that liver fibrosis reflects pathways driving vascular injury in severe obesity.

In clinical practice, adding fibrosis assessment can refine cardiovascular risk stratification and help prioritize patients for intensified risk modification.