Liver Fibrosis as a Predictor of Cardiovascular Risk in Patients with Severe Obesity

<b>Background:</b> Obesity is a substantial global health issue associated with increased risk of cardiovascular disease (CVD) and metabolic dysfunction-associated steatotic liver disease (MASLD). Despite the known link between obesity, CVD and MASLD, it remains unknown which factors contribute to higher cardiovascular (CV) risk in patients with obesity-induced liver fibrosis. Liver fibrosis, assessed by the Fibrosis-4 (FIB-4) index, may help to identify patients with obesity at increased CV risk. <b>Methods:</b> Patients with severe obesity (Body Mass Index (BMI) ≥ 40 kg/m²) scheduled for bariatric surgery were subdivided into FIB-4 categories. Systemic leukocyte activation markers were measured by flow cytometry. Additionally, markers of vascular damage, namely the carotid intima media thickness (cIMT) and pulse wave velocity (PWV), were included. <b>Results:</b> The cohort predominantly consisted of women (74%) with an average age of 41 years and mean BMI of 42.7 kg/m². Patients with an elevated FIB-4 (≥1.3) had higher systolic (146 ± 16 vs. 139 ± 15, <i>p</i> = 0.002) and diastolic blood pressure (91 ± 13 vs. 83 ± 12, <i>p</i> = 0.002), increased cIMT (0.66 ± 0.11 vs. 0.55 ± 0.10, <i>p</i> < 0.001), and higher PWV (8.2 ± 0.9 vs. 6.8 ± 1.1, <i>p</i> < 0.001) compared to those with a low FIB-4 (<1.3). Additionally, patients with a high FIB-4 tended to show increased expression of CD66b on granulocytes. <b>Conclusions:</b> Patients with severe obesity who were at risk of liver fibrosis showed greater signs of vascular damage, insulin resistance, and systemic inflammation. This suggests that liver fibrosis can be a useful marker for identifying patients with obesity at high CV risk.