The Association Between Fibrosis‐4 Index and All‐Cause and Cardiac Mortality in Patients With Coronary Heart Disease Combined With Diabetes or Prediabetes: Findings From Two Large‐Scale Prospective Cohort Studies

ABSTRACT Determining the link between fibrosis‐4 index (FIB‐4) score, which serves as a noninvasive metric for identifying liver cirrhosis, and mortality risks from all causes and cardiac causes in individuals with diabetes or prediabetes and confirmed cardiovascular disease remains ambiguous. This study seeks to explore the impact of FIB‐4 on all‐cause and cardiac mortality within this high‐risk clinical group. Two large‐scale patient cohorts were utilized for evaluation: patients from Fuwai Hospital ( N = 20,133) and the UK Biobank ( N = 5678). Multivariable Cox regression analysis was employed to estimate hazard ratios (HRs) along with the associated 95% confidence intervals (CIs). In the fully adjusted models, the elevated FIB‐4 category showed a significant association with elevated hazards of all‐cause death (Fuwai Cohort: HR 2.58, 95% CI 1.95–3.42; UKB Cohort: HR 1.26, 95% CI 1.06–1.50) and cardiac mortality (Fuwai Cohort: HR 2.99, 95% CI 1.92–4.66; UKB Cohort: HR 1.41, 95% CI 1.08–1.84). Consistent findings were observed in subgroups based on glucose levels, age, sex, and body mass index. Liver fibrosis, assessed via FIB‐4, showed a significant association with elevated mortality hazards and ought to be incorporated into risk stratification among individuals with coronary heart disease concomitant with either diabetes or prediabetic states.