Liver Fibrosis Score Can Predict Carotid Atherosclerosis in an Asymptomatic Korean Population

Background: Early identification of carotid atherosclerosis (CAS) is critical for preventing cardiovascular events at the asymptomatic stage.Todate, few studies have been performed to predict asymptomatic CAS using liver fibrosis scores in the general Korean population.This study aimed to evaluate the performance of liver fibrosis algorithms to screen CAS in the Korean population.Methods: This study comprised of 18,961 asymptomatic Korean adults who underwent carotid ultrasonography and serum biochemical testing at a comprehensive health promotion center.CAS was defined as having increased carotid intima-media thickness (CIMT 1.00 mm), carotid plaque, and/or carotid stenosis: CAS I (CIMT 1.00-1.99mm), CAS II (CIMT2.00mm).Hepatic fibrosis indices, including the NAFLD fibrosis score (NFS), fibrosis-4 (FIB-4), Forn's score, aspartate aminotransferase-to-platelet ratio index (APRI), aspartate aminotransferase/alanine aminotransferase ratio (AAR), and BARD score were evaluated.Results: The frequency of asymptomatic CAS in the Korean adult population was 35% (6,585/18,961), comprised of CAS I (29%, 5,440/ 18,961), CAS II (6%, 1,145/18,961).The Forn's score showed the highest area under the receiver operating characteristic curve (AUROC: 0.774, 95% CI, 0.767-0.781)for CAS II, followed by the FIB-4 (0.755), and NFS (0.742).CAS was diagnosed in 55% (3,618/6,585) of the asymptomatic individuals using Forn's score without carotid ultrasonography.Conclusions: This study demonstrated that Forn's score can be useful for screening CAS in an asymptomatic Korean population.Liver fibrosis markers could be used as an indication for carotid ultrasonography in primary clinical or health check-up settings.