Evaluating the prognostic value of the Fatty Liver Index for cardiovascular events with a focus on acute coronary syndrome: A narrative review

Cardiovascular diseases (CVDs), including acute coronary syndrome (ACS), pose a significant global health risk, highlighting the need for early identification and intervention in high-risk individuals to reduce morbidity and mortality. The Fatty Liver Index (FLI), a surrogate marker of metabolic dys-function-associated fatty liver disease (MASLD), has emerged as a useful tool for detecting individuals at elevated cardiovascular risk. Elevated FLI may indicate ACS risk via shared mechanisms, including insulin resistance, inflammation, dyslipidemia, and oxidative stress; however, its predictive value remains under investigation. This narrative review aims to synthesise current evidence and address gaps in the literature on the role of FLI as a predictor of ACS.
An extensive literature search was conducted in PubMed, Scopus, Embase, Web of Science, and Google Scholar (2015-2025), supplemented by manual screening of relevant journals and reference lists. Analysis of multiple cohort and observational studies indicates that elevated FLI is consistently associated with higher cardiovascular risk, including coronary events, and can serve as a practical marker for identifying individuals at heightened risk.
Despite its simplicity, non-invasiveness, and cost-effectiveness, FLI has limitations, such as variability in predictive accuracy across populations and the influence of metabolic confounders. Our study highlights FLI as a valuable tool for early detection and risk stratification of CVD and MI. Integrating FLI into global hospital screening programs could enhance preventive strategies, particularly in resource-limited settings. Further large-scale studies are needed to validate optimal cutoffs and confirm their predictive utility across diverse populations.