A Free Liver Score Tracks Heart Risk in Type 2 Diabetes

Jeff's Daily Pick. There's a liver score your doctor can calculate from blood tests you already had. In people with type 2 diabetes, a higher score went with more heart attacks and strokes.

In Vietnam, a prospective study published on October 7, 2026 in Frontiers in Gastroenterology followed adults with type 2 diabetes for two years and found that the Fibrosis 4 index, or FIB-4, was associated with cardiovascular events. FIB-4 is computed from age, the liver enzymes AST and ALT, and the platelet count, all routine blood tests. It was designed to flag liver scarring. Several 2026 studies now link it to the heart as well.

The Vietnamese cohort

Of 452 patients screened, 284 entered the cohort and 280 contributed follow up. At baseline, 72.5% had metabolic dysfunction associated fatty liver disease, and 23.9% had significant fibrosis on elastography. Over 544.92 person years, there were 11 expanded major cardiovascular events and 5 conventional ones. Each increase of one interquartile range in FIB-4 (0.696 units) was associated with expanded events, with an adjusted hazard ratio of 1.56 (95% CI 1.09 to 1.99; p = 0.022). Fatty liver itself was not statistically significant. With 11 events, the authors call for larger multicenter cohorts.

The larger picture

Bigger datasets point the same way. In the European Heart Journal this year, 318,308 UK Biobank participants free of liver and heart disease were followed for a median of 14.0 years, with 32,637 cardiovascular events. The highest quarter of FIB-4 carried an adjusted hazard ratio of 1.66 (95% CI 1.60 to 1.73) against the lowest. In Frontiers in Endocrinology on October 15, among 8,221 people with type 2 diabetes, 1,811 developed heart failure; greater swings in FIB-4 over time (HR 1.73) and persistently high values (HR 1.73) were linked to higher risk.

The value of FIB-4 is that it costs nothing extra: the inputs sit in most blood panels. In diabetes, it is already recommended to screen for liver fibrosis. These studies suggest the same number deserves a look from the cardiologist, as one more flag next to blood pressure and cholesterol rather than a replacement for them.