FIBFAR: Hemodynamic-Inflammatory Phenotype Associated with Subclinical Carotid Atherosclerosis in Patients with Cardiometabolic Risk

Background: Systemic inflammation and hemodynamic alterations represent complementary pathophysiological mechanisms involved in cardiovascular disease.The identification of integrative phenotypes using noninvasive tools could contribute to better characterization of subclinical atherosclerosis.Objective: To evaluate the association between the low-flow, high-systemic vascular resistance hemodynamic-inflammatory phenotype (FIBFAR) and the presence of carotid plaque in patients with cardiometabolic risk, defined by the presence of hypertension and diabetes or prediabetes.Methods: An observational, analytical, cross-sectional study based on a retrospective analysis of 243 outpatients aged ≥18 years with hypertension and diabetes mellitus or prediabetes.Clinical, biochemical, and hemodynamic variables were analyzed, including high-sensitivity C-reactive protein (hs-CRP), cardiac index (CI), and systemic vascular resistance (SVR) measured by impedance cardiography.Carotid plaque was assessed using Doppler ultrasound.The association between FIBFAR (hs-CRP ≥2.5 mg/L, CI <2.5 L/min/m², and SVR >1600 dynes•s•cm -5 ) and carotid plaque was assessed using multivariate logistic regression.Results: The median age was 58 years (IQR 49-67), and 64.0% were male.The prevalence of carotid plaque was 37.0%.The FIBFAR phenotype was present in 23.0% of the cohort and was independently associated with carotid plaque (OR 8.60; 95% CI: 4.39-17.70;p < 0.001), along with age ≥65 years (OR 1.94; 95% CI: 1.01-3.72;p = 0.047).The model showed appropriate calibration (Hosmer-Lemeshow p = 0.374) and moderate discriminatory power (AUC = 0.73; 95% CI: 0.66-0.79;p < 0.001).Conclusions: In patients with cardiometabolic risk, the FIBFAR phenotype was independently associated with subclinical carotid atherosclerosis.Given the cross-sectional design, these findings should be interpreted as statistical associations and require prospective validation before their clinical application can be considered.