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June 7, 2026Diabetes

Prevalence of MACE (53.6%, 58.8%, 70.3%) and all-cause mortality (4.4%, 6.6%, 14.2%) increased stepwise across low, indeterminate, and high FIB-4 categories (all p≤0.001).

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Why the study?

Does a higher Fibrosis-4 (FIB-4) index predict greater ASCVD burden, MACE, and mortality in adults with Type 2 Diabetes?

Population

8,900 adults with Type 2 Diabetes Mellitus receiving care at Weill Cornell Medicine, mean age 71 ± 11 years…

Comparison

High or indeterminate Fibrosis-4 index vs Low (<1.3) Fibrosis-4 (FIB-4) index

Design

Cohort

Authors

MMMelina I. ManolasSBSARAH BARENBAUMMYMichele Yeung

Discussion

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Overview

In adults with T2DM, a higher FIB-4 index is significantly associated with increased prevalence of MACE, all-cause mortality, CAD, and stroke, suggesting its utility as an integrative cardiometabolic risk marker.

Key Points

  • This research aims to clarify the relationship between the FIB-4 index and ASCVD outcomes in adults with type 2 diabetes mellitus (T2DM).
  • Conducted a unicenter retrospective study of 8,900 adults with T2DM from 2016-2023
  • Identified T2DM and ASCVD using ICD-10 codes and laboratory data
  • Categorized FIB-4 into low, indeterminate, and high for outcome analysis.
  • 32.3% had low, 42.7% indeterminate, and 11.0% high FIB-4; higher FIB-4 linked to older age and chronic conditions
  • MACE prevalence increased across FIB-4 categories: 53.6% (low), 58.8% (indeterminate), 70.3% (high)
  • All-cause mortality rates also rose with FIB-4: 4.4% (low), 6.6% (indeterminate), 14.2% (high).

Structured PICO

Does a higher Fibrosis-4 (FIB-4) index predict greater ASCVD burden, MACE, and mortality in adults with Type 2 Diabetes?

P
Population
8,900 adults with Type 2 Diabetes Mellitus (T2DM) receiving care at Weill Cornell Medicine (2016-2023), mean age 71 ± 11 years, 43% female. Baseline CVD subtypes included 67% CAD, 30% PAD, and 40% stroke.
I
Intervention
High (>2.67) or indeterminate (1.3-2.67) Fibrosis-4 (FIB-4) index
C
Comparator
Low (<1.3) Fibrosis-4 (FIB-4) index
O
Outcome
ASCVD, MACE, and all-cause mortalitycomposite

In adults with T2DM, a higher FIB-4 index is significantly associated with increased prevalence of MACE, all-cause mortality, CAD, and stroke, suggesting its utility as an integrative cardiometabolic risk marker.

Cite This Study

Manolas et al. (2026) studied this question.

synapsesocial.com/papers/6a250b4c7def13d035e1b3efhttps://doi.org/10.2337/db26-1427-p
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Also Consider

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  1. 11764-P: Inflammation, Body Mass Index, and Cardiovascular Outcomes in Chronic Kidney Disease and Type 2 Diabetes2026
  2. 21404-P: Obesity Drives Cardiac Hypertrophy while Diabetic Kidney Disease Links to Myocardial Edema and Vascular Stiffness in Young Adults with Type 2 Diabetes2026
  3. 3Abstract A151: Fib-4 score correlations with lifestyle and health factors in a high-risk, diverse population: Baseline findings from a randomized tailored disease management intervention for hepatocellular carcinoma (HCC) prevention2025
  4. 4Fibrosis-4 index as a predictor of all-cause and cardiovascular mortality in patients with chronic kidney disease2025
  5. 5Prognostic significance of FIB-4 versus FIB-5 in non-ST-segment-elevation acute coronary syndrome2025