Association Between Liver Fibrosis and Risk of Incident Stroke and Mortality: A Large Prospective Cohort Study
Background There is a well‐established relationship between liver conditions and cardiovascular diseases. However, uncertainty persists regarding the contribution of liver fibrosis to major stroke types including ischemic stroke, intracerebral hemorrhage, and subarachnoid hemorrhage at the populatio...
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Wiley
2025-02-01
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| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
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| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.124.037081 |
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| author | Zijie Wang Zhitao Gong Jianshang Wen Shanyu Zhang Xiao Hu Wenliang Guo Yanghua Tian Qi Li |
| author_facet | Zijie Wang Zhitao Gong Jianshang Wen Shanyu Zhang Xiao Hu Wenliang Guo Yanghua Tian Qi Li |
| author_sort | Zijie Wang |
| collection | DOAJ |
| description | Background There is a well‐established relationship between liver conditions and cardiovascular diseases. However, uncertainty persists regarding the contribution of liver fibrosis to major stroke types including ischemic stroke, intracerebral hemorrhage, and subarachnoid hemorrhage at the population level. Methods In this large prospective cohort study, participants without previous stroke or coronary heart disease at baseline from the UK Biobank were included. We identified participants at high probability of advanced liver fibrosis using the Fibrosis‐4 index >2.67 or aspartate aminotransferase to platelet ratio index ≥1.0. Multivariable Cox proportional hazard regression analyses were conducted to estimate hazard ratios (HRs) for liver fibrosis with the incidence of major stroke types, stroke‐related death, and all‐cause death. Results Among 379 953 participants (mean age, 56.2 [SD, 8.1] years; 44.6% men), 7396 (1.9%) had a Fibrosis‐4 index >2.67 at baseline. During a median follow‐up of 12.75 (interquartile range, 12.03–13.48) years, 7143 (1.9%) incident stroke cases were documented. Advanced liver fibrosis assessed by the Fibrosis‐4 index was associated with an increased risk of ischemic stroke (HR, 1.94 [95% CI, 1.70–2.22]), intracerebral hemorrhage (HR, 2.14 [95% CI, 1.63–2.81]), subarachnoid hemorrhage (HR, 1.90 [95% CI, 1.27–2.84), stroke‐related death (HR, 2.20 [95% CI, 1.73–2.80]), and all‐cause death (HR, 2.59 [95% CI, 2.46–2.73]). Using the aspartate aminotransferase to platelet ratio index as an alternative score, liver fibrosis was correlated with magnified risk of intracerebral hemorrhage (HR, 3.76 [95% CI, 2.38–5.93]) and subarachnoid hemorrhage (HR, 3.05 [95% CI, 1.51–6.13]) compared with ischemic stroke (HR, 1.58 [95% CI, 1.17–2.14]). Restricted cubic spline analysis showed nonlinear associations of the Fibrosis‐4 index and aspartate aminotransferase to platelet ratio index with stroke incidence and all‐cause death. Conclusions Liver fibrosis is associated with increased risk of incident stroke and death among people without previous stroke or cardiovascular events, with particularly greater risk of intracerebral hemorrhage and subarachnoid hemorrhage. Noninvasive indices of liver fibrosis may serve as an easily accessible marker to detect individuals facing elevated risk of stroke and death in the primary prevention settings. |
| format | Article |
| id | doaj-art-85e6674b5e73459686a415b5f571f7a4 |
| institution | Kabale University |
| issn | 2047-9980 |
| language | English |
| publishDate | 2025-02-01 |
| publisher | Wiley |
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| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj-art-85e6674b5e73459686a415b5f571f7a42025-02-04T11:00:01ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802025-02-0114310.1161/JAHA.124.037081Association Between Liver Fibrosis and Risk of Incident Stroke and Mortality: A Large Prospective Cohort StudyZijie Wang0Zhitao Gong1Jianshang Wen2Shanyu Zhang3Xiao Hu4Wenliang Guo5Yanghua Tian6Qi Li7Department of Neurology The Second Affiliated Hospital of Anhui Medical University Hefei ChinaDepartment of Rehabilitation Medicine The Second Affiliated Hospital of Anhui Medical University Hefei ChinaDepartment of Neurology Shucheng People’s Hospital Lu’an ChinaDepartment of Neurology The Second Affiliated Hospital of Anhui Medical University Hefei ChinaDepartment of Neurology The First Affiliated Hospital of Chongqing Medical University Chongqing ChinaDepartment of Neurology The Second Affiliated Hospital of Anhui Medical University Hefei ChinaDepartment of Neurology The Second Affiliated Hospital of Anhui Medical University Hefei ChinaDepartment of Neurology The Second Affiliated Hospital of Anhui Medical University Hefei ChinaBackground There is a well‐established relationship between liver conditions and cardiovascular diseases. However, uncertainty persists regarding the contribution of liver fibrosis to major stroke types including ischemic stroke, intracerebral hemorrhage, and subarachnoid hemorrhage at the population level. Methods In this large prospective cohort study, participants without previous stroke or coronary heart disease at baseline from the UK Biobank were included. We identified participants at high probability of advanced liver fibrosis using the Fibrosis‐4 index >2.67 or aspartate aminotransferase to platelet ratio index ≥1.0. Multivariable Cox proportional hazard regression analyses were conducted to estimate hazard ratios (HRs) for liver fibrosis with the incidence of major stroke types, stroke‐related death, and all‐cause death. Results Among 379 953 participants (mean age, 56.2 [SD, 8.1] years; 44.6% men), 7396 (1.9%) had a Fibrosis‐4 index >2.67 at baseline. During a median follow‐up of 12.75 (interquartile range, 12.03–13.48) years, 7143 (1.9%) incident stroke cases were documented. Advanced liver fibrosis assessed by the Fibrosis‐4 index was associated with an increased risk of ischemic stroke (HR, 1.94 [95% CI, 1.70–2.22]), intracerebral hemorrhage (HR, 2.14 [95% CI, 1.63–2.81]), subarachnoid hemorrhage (HR, 1.90 [95% CI, 1.27–2.84), stroke‐related death (HR, 2.20 [95% CI, 1.73–2.80]), and all‐cause death (HR, 2.59 [95% CI, 2.46–2.73]). Using the aspartate aminotransferase to platelet ratio index as an alternative score, liver fibrosis was correlated with magnified risk of intracerebral hemorrhage (HR, 3.76 [95% CI, 2.38–5.93]) and subarachnoid hemorrhage (HR, 3.05 [95% CI, 1.51–6.13]) compared with ischemic stroke (HR, 1.58 [95% CI, 1.17–2.14]). Restricted cubic spline analysis showed nonlinear associations of the Fibrosis‐4 index and aspartate aminotransferase to platelet ratio index with stroke incidence and all‐cause death. Conclusions Liver fibrosis is associated with increased risk of incident stroke and death among people without previous stroke or cardiovascular events, with particularly greater risk of intracerebral hemorrhage and subarachnoid hemorrhage. Noninvasive indices of liver fibrosis may serve as an easily accessible marker to detect individuals facing elevated risk of stroke and death in the primary prevention settings.https://www.ahajournals.org/doi/10.1161/JAHA.124.037081liver fibrosisdeathpopulation‐based studystroke |
| spellingShingle | Zijie Wang Zhitao Gong Jianshang Wen Shanyu Zhang Xiao Hu Wenliang Guo Yanghua Tian Qi Li Association Between Liver Fibrosis and Risk of Incident Stroke and Mortality: A Large Prospective Cohort Study Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease liver fibrosis death population‐based study stroke |
| title | Association Between Liver Fibrosis and Risk of Incident Stroke and Mortality: A Large Prospective Cohort Study |
| title_full | Association Between Liver Fibrosis and Risk of Incident Stroke and Mortality: A Large Prospective Cohort Study |
| title_fullStr | Association Between Liver Fibrosis and Risk of Incident Stroke and Mortality: A Large Prospective Cohort Study |
| title_full_unstemmed | Association Between Liver Fibrosis and Risk of Incident Stroke and Mortality: A Large Prospective Cohort Study |
| title_short | Association Between Liver Fibrosis and Risk of Incident Stroke and Mortality: A Large Prospective Cohort Study |
| title_sort | association between liver fibrosis and risk of incident stroke and mortality a large prospective cohort study |
| topic | liver fibrosis death population‐based study stroke |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.124.037081 |
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