Adults whose three routine liver scores all landed in the worst quarter had about 2.5 times the risk of a major heart event over the following years, according to a study of 318,308 people published September 7, 2026 in the European Heart Journal. Every one of those adults was free of diagnosed liver disease and heart disease when the study began, and all three scores are calculated from blood tests that most people have already had.
Key takeaways
- In 318,308 adults followed for a median of 14 years, 32,637 had a major heart event, or 10.3% of the group.
- Each of three liver scores predicted heart events on its own, and people in the worst quarter of all three had about 2.5 times the risk of people in the best quarter.
- All three scores are arithmetic on lab values already in a standard blood panel, so no new test is involved.
What the study found
Researchers at Fuwai Hospital in Beijing tracked 318,308 adults who had no clinical liver disease and no cardiovascular disease at the start. Over a median follow-up of 14 years, 32,637 of them had a major cardiovascular event, defined in the study as heart attack, heart failure, atrial fibrillation, ischemic stroke, or death from cardiovascular causes.
The team scored each person on three noninvasive liver measures. The fatty liver index estimates fat in the liver. The FIB-4 index estimates scarring. The albumin bilirubin score estimates how well the liver is still doing its job.
After adjusting for other risk factors, each score predicted heart events on its own. Compared with the best quarter of the group, people in the worst quarter had:
- About 46% higher risk on the fatty liver index (adjusted hazard ratio 1.46, very likely between 40% and 52% higher).
- About 66% higher risk on FIB-4 (adjusted hazard ratio 1.66, very likely between 60% and 73% higher).
- About 42% higher risk on the albumin bilirubin score (adjusted hazard ratio 1.42, very likely between 37% and 47% higher).
People who were in the worst quarter on all three at once had about 2.53 times the risk, and the true figure is very likely between 2.38 and 2.70 times.
The pattern also split by sex. The fatty liver index was more strongly tied to heart events in women, while FIB-4 and the albumin bilirubin score carried more risk in men.
Dr. Kumar’s take
The useful part of this study is that it asks for nothing new. The fatty liver index, FIB-4, and the albumin bilirubin score are formulas fed by numbers a person may already have: a metabolic panel, a liver panel, a blood count, plus height, weight, and waist size. Most adults with recent lab work are carrying this information around unread in their own chart.
The honest limit sits inside the first of those three scores. The fatty liver index is built largely from body mass index, waist circumference, and triglycerides. Those are ordinary metabolic risk factors for heart disease on their own, so part of what reads here as a liver signal is familiar metabolic risk being counted a second time. FIB-4 and the albumin bilirubin score lean on different inputs, which is why the combined result is more interesting than any single index.
This is also observational. It shows that people with worse liver numbers went on to have more heart events. It cannot show that the liver caused those events, or that improving a liver score would prevent one. Studies keep finding that trouble in one organ tracks with trouble in the heart, from gum disease to hormonal and metabolic conditions like PCOS. Shared underlying biology explains a lot of that, and treating the marker is not the same as treating the cause.
What it means for you
If you have had blood work in the past year, the raw ingredients for all three scores are probably in it. A mildly abnormal liver enzyme or a low platelet count is often glanced at and dropped. In this data, those same values, combined, sorted people into meaningfully different heart risk groups.
Worth asking at your next visit whether your liver numbers, read together rather than one line at a time, change how your cardiovascular risk should be estimated. The levers that move these scores are the familiar ones: weight, waist size, alcohol, triglycerides, blood sugar, and diet. A long term shift toward plant based eating moves several of them at once.
None of this replaces standard risk scoring. It is a reminder that information you already paid for may be sitting unused.