Association between fibrosis-4 index and coronary heart disease: a population-based study

Although the fibrosis-4 index (FIB‐4) was initially established as a liver fibrosis marker, recent studies have demonstrated its significant association with elevated risk of coronary artery disease(CHD). This study was conducted using data from five National Health and Nutrition Examination Surveys (NHANES) cycles between 2009 and 2018. Multivariable logistic regression analysis revealed a significant, positive relationship between FIB-4 and CHD.In sensitivity analyses, the highest FIB-4 quartile (Q4) showed a 4.22-fold increased CHD risk versus Q1 (OR = 4.22, 95% CI:1.93–9.24, P = 0.0005), with significant dose-response trends across quartiles (P < 0.05). Receiver operating characteristic (ROC) analysis revealed FIB-4 had good discriminative power for CHD (AUC = 0.80, 95%CI:0.78–0.81), with 75.9% sensitivity and 30.2% specificity at the optimal cutoff of 1.31. Restricted cubic splines (RCS) analysis revealed a nonlinear dose-response relationship between FIB-4 and CHD risk (P < 0.0001), with accelerated risk elevation beyond the inflection point (FIB-4 = 2.73). Subgroup analyses confirmed FIB-4’s robust association with CHD risk (overall OR = 1.66, 95%CI:1.57–1.76), with stronger effects in males (vs. females, Pinteraction = 0.042), non-diabetics (vs. diabetics, Pinteraction < 0.001), and racial minorities (highest OR = 2.36 in ‘Other Race’).These findings underscore the potential of FIB-4 as a novel biomarker for CHD risk assessment in clinical practice.