Clinically Accessible Liver Fibrosis Association with CT Scan Coronary Artery Disease Beyond Other Validated Risk Predictors: The ICAP Experience

<b>Background/objectives:</b> Cardiovascular risk (CVR) stratification in clinical settings remains limited. This study aims to evaluate clinical parameters that could improve the identification of higher-than-expected coronary artery disease (CAD) in CT scan coronarography. <b>Methods:</b> In a cross-sectional study of asymptomatic patients from the Integrated Cardiovascular Assessment Program (ICAP), volunteers aged 40-80 without diagnosed cardiovascular disease were assessed. CVR factors like obesity, lipid and glucose profiles, liver fibrosis risk (FIB-4 ≥ 1.3), C-reactive protein, and family history of CVD were evaluated. Patients were stratified by CVR following ESC guidelines. "CVR excess" was defined as CAD-RADS ≥ 2 in low-to-moderate-risk (LMR), CAD-RADS ≥ 3 in high-risk (HR), and CAD-RADS ≥ 4 in very-high-risk (VHR) groups. <b>Results:</b> Among 219 patients (mean age 57.9 ± 1.15 years, 14% female), 43.4% were classified as LMR, 49.3% as HR, and 7.3% as VHR. "CVR excess" was observed in 18% of LMR, 15% of HR, and 19% of VHR patients. LMR patients with prior statin use and HR patients with obesity were more likely to have "CVR excess" (<i>p</i> < 0.01 and <i>p</i> < 0.05, respectively). FIB-4 modified the effect of statin use and obesity on "CVR excess" prediction (<i>p</i> for interactions < 0.05). Models including age, sex, and both interactions showed a strong discrimination for "CVR excess" in LMR and HR groups (AUROC 0.84 (95% CI 0.73-0.95) and 0.82 (95% CI 0.70-0.93), respectively). <b>Conclusions:</b> Suspected liver fibrosis combined with statin use in LMR patients and obesity in HR patients is associated with CVR excess, providing potential indications for image CAD assessment in asymptomatic patients.