High Fibrinogen-to-Albumin Ratio Linked to Increased Mortality in ASCVD Patients with Diabetes: Study Shows
China: A newly published study in Frontiers in Endocrinology highlights the prognostic significance of the fibrinogen-to-albumin ratio (FAR) in patients suffering from both atherosclerotic cardiovascular disease (ASCVD) and diabetes mellitus (DM). Researchers, led by Haixu Yu from the Department of Cardiology at Beijing Jishuitan Hospital, Capital Medical University, Beijing, China, explored whether FAR could serve as an independent predictor of long-term mortality in this high-risk group.
FAR, a marker of systemic inflammation, has previously shown predictive value in conditions such as heart failure and certain cancers. However, its relevance in individuals with ASCVD, particularly those with concurrent diabetes, has not been comprehensively investigated until now.
Drawing on data from the U.S. National Health and Nutrition Examination Survey (NHANES) between 1999 and 2002, the research team analyzed a cohort of 821 adults diagnosed with ASCVD. Mortality data were tracked through December 31, 2019, providing a median follow-up period of 15.6 years. Participants were categorized into two groups based on their FAR levels: a high FAR group (FAR_H) and a low FAR group (FAR_L).
The analysis revealed the following findings:
- Among ASCVD patients with diabetes, those with a high fibrinogen-to-albumin ratio (FAR_H) had nearly double the risk of all-cause mortality compared to those with low FAR (HR: 1.90).
- In the overall ASCVD population, elevated FAR was linked to a 55% higher risk of death (HR: 1.55).
- A significant interaction was observed between FAR and diabetes status, indicating that the combination of high inflammation and diabetes may further worsen survival outcomes.
The study’s findings point to FAR as a promising biomarker that could enhance risk stratification strategies for ASCVD patients, especially those with coexisting diabetes. Given the high global burden of both ASCVD and diabetes, such predictive tools are vital for early intervention and tailored patient management.
However, the researchers also acknowledged several limitations. The use of baseline FAR measurements without tracking dynamic changes over time may have impacted the precision of the findings. The study population was exclusively American, raising questions about the generalizability of results to other ethnic groups. Additionally, the relatively small sample size limited subgroup analyses based on variables like age and sex. The authors also noted the need for further research to explore the biological mechanisms linking FAR to adverse outcomes.
The authors concluded, "Elevated FAR emerged as an independent risk factor for long-term mortality among ASCVD patients with diabetes. The combined use of FAR and diabetes status could offer valuable insights into prognosis and guide clinical decision-making in this vulnerable population."
Reference:
Yu, H., Fan, Y., Wang, J., & Liu, W. (2025). Fibrinogen-to-albumin ratio predicts mortality in patients with diabetes mellitus and atherosclerotic cardiovascular disease. Frontiers in Endocrinology, 16, 1539114. https://doi.org/10.3389/fendo.2025.1539114
