Circulating fibroblast growth factor-21 in coronary artery disease: a systematic review and meta-analysis

OpenAlex İngilizce

BACKGROUND: Fibroblast growth factor-21 (FGF21) is a metabolic regulator involved in glucose and lipid homeostasis and has emerged as a potential biomarker in cardiometabolic diseases. The relationship between circulating FGF21 levels and coronary artery disease (CAD) remains unclear. We performed a systematic review and meta-analysis to clarify this association and assess its clinical relevance. METHODS: PubMed, Web of Science, and Scopus were searched for observational studies reporting circulating FGF21 levels in adult CAD patients. Standardized mean differences (SMDs) with 95% confidence intervals were calculated using a random-effects model. Subgroup and meta-regression analyses were conducted to explore heterogeneity. RESULTS: Fourteen studies including 2963 CAD patients were analyzed. Circulating FGF21 levels were significantly higher in CAD patients than in controls (SMD = 0.90; 95% CI: 0.26-1.54; p = 0.0056). In acute CAD, the increase was more pronounced (SMD = 1.70; 95% CI: 0.20-3.21). Elevated FGF21 persisted even when diabetes prevalence was low (SMD = 1.50; 95% CI: 0.15-2.84). Meta-regression identified BMI and HDL as independent contributors to inter-study variability. Sensitivity analyses confirmed robustness, and no strong evidence of publication bias was detected. CONCLUSIONS: Circulating FGF21 is elevated in CAD, primarily reflecting metabolic disturbances-particularly adiposity and dyslipidemia-rather than diabetes or CAD itself. Levels tend to be higher during acute events, suggesting that FGF21 may serve as a marker of metabolic stress and lipid abnormalities rather than a direct diagnostic biomarker.