A. N. Saidi, Franciscus Gasthuis & Vlietland, Rotterdam, the Netherlands; W. B. Theel, Franciscus Gasthuis & Vlietland, Rotterdam, the Netherlands; V. D. de Jong, UMC Utrecht, Utrecht, the Netherlands; S. R. van Mil, Erasmus MC, Rotterdam, the Netherlands; A. J. van der Lelij, Erasmus MC, Rotterdam, the Netherlands; D. E. Grobbee, UMC Utrecht, Utrecht, the Netherlands; J. Apers, Franciscus Gasthuis & Vlietland, Rotterdam, the Netherlands; E. van der Zwan, Franciscus Gasthuis & Vlietland, Rotterdam, the Netherlands; M. Castro Cabezas, Franciscus Gasthuis & Vlietland, Rotterdam, the Netherlands. a.saidi@franciscus.nl

Background: Obesity is linked to increased cardiovascular disease (CVD) and metabolic dysfunction-associated steatotic liver disease (MASLD). The role of liver fibrosis in elevating cardiovascular risk in obesity remains unclear. The Fibrosis-4 (FIB-4) index may identify obese patients at higher cardiovascular risk.

Methods: We studied 200 patients with severe obesity (BMI ≥ 40 kg/m²) scheduled for bariatric surgery at Franciscus Gasthuis Hospital. We measured systemic leukocyte activation markers, carotid intima media thickness (cIMT), pulse wave velocity (PWV), and the Fibrosis-4 (FIB-4) index.

Results: The cohort (74% women, average age 41, mean BMI 42.7 kg/m²) showed that patients with elevated FIB-4 (≥1.3) had higher systolic (146 ± 15.4 vs. 139 ± 15.8 mmHg, p=0.002) and diastolic blood pressure (91 ± 13 vs. 83 ± 12 mmHg, p=0.002), increased cIMT (0.66 ± 0.11 mm vs. 0.55 ± 0.10, p<0.001), and higher PWV (8.2 ± 0.9 vs. 6.8 ± 1.1, p<0.001) compared to those with low FIB-4 (<1.3). A positive correlation was found between CD66b on granulocytes and FIB-4 (rho = 0.177, p=0.012).

Discussion/conclusion: 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 obese patients at high cardiovascular risk.