In conclusion, this study provides compelling evidence that liver fibrosis, as estimated by the FIB-4 index, is an independent and graded risk factor for sudden cardiac arrest (SCA). These findings illuminate a previously underrecognized dimension of the liver-heart axis and propose a practical tool for enhancing SCA risk stratification. Future research should focus on elucidating the underlying biological mechanisms and evaluating the efficacy of targeting high FIB-4 individuals for specific interventions to mitigate SCA risk.