Researchers studied over 6,500 people with fatty liver disease to understand how a specific blood test called the atherogenic index of plasma (AIP) could predict who might have heart problems or die early. They followed these people for about 10 years and found that people with higher AIP scores—especially those under 60 years old—had a greater risk of dying from heart disease. The study suggests that doctors might use this simple blood test to identify patients who need extra care to prevent serious health problems.

The Quick Take

  • What they studied: Whether a blood test that measures how fatty and unhealthy your cholesterol is (called AIP) can predict who will have heart problems or die early if they have fatty liver disease.
  • Who participated: 6,567 people from the United States with fatty liver disease, tracked from 1999 to 2018. The group included people of different ages, with an average follow-up time of about 10 years.
  • Key finding: People with higher AIP scores had a 34% increased risk of dying from heart disease. Younger people (under 60) with high AIP scores had a 25% increased risk of dying from any cause. The relationship wasn’t simple—risk jumped up significantly when AIP went above 1.71.
  • What it means for you: If you have fatty liver disease, your doctor might use this blood test to figure out if you’re at higher risk for heart problems. This could help catch problems early, especially if you’re under 60. However, this is one study, and doctors need more research before making this a standard test.

The Research Details

This was a cohort study, which means researchers followed a large group of people over time and watched what happened to them. They used data from the National Health and Nutrition Examination Survey (NHANES), a long-running government health study that tracks Americans’ health. The researchers divided people into four groups based on their AIP scores and compared death rates between groups. They used advanced statistical methods to account for other factors that might affect health, like age, smoking, and diabetes. The study followed people for a median of about 10 years, with some people tracked for up to 20 years.

This research approach is strong because it follows real people over many years and uses actual death records from the National Death Index. This gives researchers real-world evidence about whether the blood test actually predicts who gets sick or dies. By dividing people into groups and comparing them, researchers can see if the blood test works better than just guessing.

This study has several strengths: it included a large number of people (6,567), used real death records rather than just asking people, and followed people for a long time. The researchers also checked their results multiple ways to make sure they were reliable. However, the study only looked at people in the United States, so results might be different in other countries. Also, the study shows a connection between the blood test and health outcomes, but doesn’t prove that the blood test itself causes the problems.

What the Results Show

During the 10-year follow-up period, 1,323 people died from any cause and 447 died specifically from heart disease. People with higher AIP scores had a 34% increased risk of dying from heart disease compared to those with lower scores. Interestingly, the relationship between AIP and death wasn’t straightforward—it followed a J-shaped pattern, meaning risk stayed relatively low until AIP reached 1.71, then jumped up significantly. When AIP was above 1.71, people had a 48% increased risk of dying from any cause. The study found that younger people (under 60) were more affected by high AIP scores than older people, suggesting age matters for how this blood test predicts health problems.

The researchers discovered that the connection between AIP and death risk was partly explained by three other health factors: blood sugar control (measured by HbA1c), white blood cell counts (neutrophils), and high blood pressure. Blood sugar control explained about 73% of why high AIP predicted early death from any cause, and 43% of why it predicted heart disease death. This suggests that people with high AIP often have problems controlling their blood sugar, which is a major reason they’re at higher risk. The study also found that the blood test was more useful for predicting problems in younger people than in older people.

This study adds to growing evidence that how your cholesterol is structured—not just how much you have—matters for heart health. Previous research has shown that AIP is a good marker for heart disease risk in the general population. This study is one of the first to specifically look at whether AIP predicts death in people with fatty liver disease, a condition that’s becoming increasingly common. The findings fit with what we know about fatty liver disease: it’s connected to problems with how the body handles fat and sugar, and these problems increase heart disease risk.

The study only included people in the United States, so results might not apply to people in other countries with different genetics or lifestyles. The researchers couldn’t prove that high AIP actually causes death—only that it’s connected to it. The study also couldn’t account for some factors that might matter, like diet quality or exercise habits. Additionally, the study found that AIP was connected to heart disease death but not to death from all causes (when looking at the simple relationship), which suggests the connection is specific to heart health rather than general health.

The Bottom Line

If you have fatty liver disease, ask your doctor about checking your AIP score, especially if you’re under 60 years old. If your AIP is elevated (above 1.71), work with your doctor on managing blood sugar, blood pressure, and cholesterol through diet, exercise, and possibly medication. These changes can help reduce your heart disease risk. However, this is based on one study, so don’t make major health decisions based solely on this research—discuss it with your healthcare provider.

This research is most relevant for people with fatty liver disease, especially those under 60 years old. It’s also important for doctors treating these patients. People without fatty liver disease might benefit from knowing about AIP as a heart disease risk marker, but this study doesn’t directly apply to them. If you’re over 60 with fatty liver disease, the findings are less clear, though the blood test might still be useful.

If you make lifestyle changes based on a high AIP score, you might see improvements in your blood sugar and cholesterol within 3-6 months. However, reducing your actual risk of heart disease or death takes longer—usually 1-2 years of consistent healthy changes. The benefits of managing these risk factors build up over time.

Want to Apply This Research?

  • Track your AIP score quarterly (every 3 months) if your doctor has calculated it. Also track related measurements: fasting blood sugar, cholesterol levels (especially triglycerides and HDL), and blood pressure. Record these in a health app with dates to see trends over time.
  • Set a goal to improve blood sugar control through consistent meal timing and reducing refined carbohydrates. Log your meals and blood sugar readings if you have a glucose monitor. For users with fatty liver disease, tracking these specific metrics helps show whether lifestyle changes are working to lower AIP.
  • Create a quarterly health review where you compare your AIP, blood sugar, and cholesterol numbers to previous quarters. Set targets with your doctor (for example, reducing AIP by 0.1 points per quarter). Use the app to set reminders for lab work and doctor visits. If you’re under 60 with elevated AIP, monitor more frequently (monthly) to catch changes quickly.

This research describes an association between a blood test (AIP) and heart disease risk in people with fatty liver disease, but does not prove cause and effect. The findings are based on one study and should not replace medical advice from your doctor. If you have fatty liver disease or concerns about heart disease risk, consult with your healthcare provider about whether AIP testing is appropriate for you and what steps you should take based on your individual health situation. This information is for educational purposes only and is not a substitute for professional medical diagnosis, treatment, or advice.