Association between non‐alcoholic fatty liver disease and risk of new‐onset atrial fibrillation in healthy adults

Roh, Jae‐Hyung; Lee, Jae‐Hwan; Lee, Hanbyul; Yoon, Yong‐Hoon; Kim, Minsu; Kim, Yong-Giun; Park, Gyung‐Min; Park, Jae‐Hyeong; Seong, In‐Whan

doi:10.1111/liv.14236

Cited by 25 publications

(25 citation statements)

References 25 publications

(45 reference statements)

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“…Another study showed that in hospitalized patients with type 2 diabetes NAFLD was associated with an increased persistent or permanent AF prevalence 31 . A recent longitudinal study showed that NAFLD, as assessed by fatty liver index, was independently associated with increased risk of new-onset AF 6 . However, in this study, liver steatosis was assessed by surrogate biochemical markers and not by imaging.…”

Section: Discussionmentioning

confidence: 99%

The risk of atrial fibrillation in patients with non-alcoholic fatty liver disease and a high hepatic fibrosis index

Park

Lee

Choi

et al. 2020

Sci Rep

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Previous epidemiological studies focusing on the association between liver disease and atrial fibrillation (AF) show interesting but inconsistent findings. Patients with liver disease have a higher AF risk; however, it is unknown whether the liver fibrosis index can predict AF risk. The medical records of a healthy population undergoing routine health examinations at Healthcare System Gangnam Center, Seoul National University Hospital, were reviewed retrospectively. After excluding subjects with a history of liver disease and known cardiovascular disease, 74,946 subjects with nonalcoholic fatty liver disease (NAFLD) were evaluated. The mean age was 51 ± 11 years, and 71.9% were male. AF was found in 380 (0.5%) subjects. Using univariate analyses, age, male sex, body mass index, hypertension, and diabetes were significantly associated with AF. The fibrosis 4 index (FIB 4) showed significant correlations with AF [unadjusted odds ratio (OR) 3.062 and 95% confidence interval (CI) 2.605-3.600, p = 0.000; adjusted OR 2.255 and 95% CI 1.744-2.915, p = 0.000, with cardiometabolic risk factors adjusted]. In conclusion, NAFLD subjects with higher FIB 4 were associated with increased AF risk. The noninvasive determination of liver fibrosis indices can have clinical implications on the early identification of NAFLD in patients at risk for AF.Atrial fibrillation (AF) is gradually increasing in incidence and prevalence in Korea 1 . AF incidence increased more than 1.12-fold from 2008 to 2015, and the AF prevalence increased by 1.68-fold during the same period. An aging population and increasing comorbidities associated with the aging process have been suggested as explanations for these increases. A substantial increase in mortality and morbidity, reducing the quality of life in AF patients, is becoming a serious medical problem in Korea 1,2 . In addition to abnormal substrate and triggering ectopic foci in the heart, various inflammatory markers have been studied to identify a link between AF and systemic inflammation, but results are inconsistent 3 .The association of AF and liver disease, with increasing prevalence of non-alcoholic fatty liver disease (NAFLD) and subsequent cirrhosis world-wide, have shown interesting results. From various previous studies regarding relation between liver diseases and AF, results have been somewhat inconsistent. A recent meta-analysis reported an approximately two-fold increased risk of AF among NAFLD patients compared with subjects without NAFLD 4 . Patients with liver cirrhosis have a 46% increased AF risk compared to controls, after covariates were adjusted 5 . In that study, the AF risk was higher in a population younger than 65 years of age, without known cardiovascular comorbidities. Another study using the fatty liver index showed an increased risk for new-onset AF in subjects with NAFLD without significant coronary disease. NAFLD predisposes individuals to AF, independent of known risk factors for atherosclerosis 6 . Shared risk factors, epicardial fat and related hormonal and cytok...

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Section: Discussionmentioning

confidence: 99%

The risk of atrial fibrillation in patients with non-alcoholic fatty liver disease and a high hepatic fibrosis index

Park

Lee

Choi

et al. 2020

Sci Rep

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“…Therefore, 19 eligible observational studies remained and were included in the meta-analysis. 19 – 36 …”

Section: Resultsmentioning

confidence: 99%

Relationship between non-alcoholic fatty liver disease and cardiac arrhythmia: a systematic review and meta-analysis

2021

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Objective We performed a meta-analysis to create a quantitative estimate of the association between non-alcoholic fatty liver disease (NAFLD) and the risk of cardiac arrhythmia (including atrial fibrillation (AF), prolonged QT interval, premature atrial/ventricular contraction [PAC/PVC] and heart block). Methods A literature review was conducted using PubMed, Embase, Web of Science and the Cochrane Library database to identify observational studies of the link between NAFLD and cardiac arrhythmia. Effect sizes were expressed as odds ratios (ORs) or hazard ratios (HRs) with 95% confidence intervals (CIs). The method of analysis of AF was also analysed separately, according to the effect estimate (OR or HR). Results Nineteen studies of 7,012,960 individuals were included. NAFLD was independently associated with higher risks of AF (OR 1.71, 95% CI: 1.14–2.57; HR 1.12, 95% CI: 1.11–1.13), prolonged QT interval (OR 2.86, 95% CI: 1.64–4.99), PAC/PVC (OR 2.53, 95% CI: 1.70–3.78) and heart block (OR 2.65, 95% CI: 1.88–3.72). The heterogeneity of the data with respect to AF and prolonged QT was moderate on sensitivity analysis. Conclusions We found a significantly higher risk of cardiac arrhythmia in patients with NAFLD, but the observational design of the studies does not permit conclusions regarding causality.

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“…Similar to MetS, the association of NAFLD with extrahepatic complications such as cardiovascular disease, chronic kidney disease and insulin resistance are well known 3,4,24 . Because potential associations with other diseases including atrial brillation and periodontitis have recently been suggested, there is increased interest in the effect of NAFLD on multiple organs 5,25 .…”

Section: Discussionmentioning

confidence: 99%

“…NAFLD is associated with an increase of multisystem diseases including diabetes, ischemic cardiovascular disease, and chronic kidney disease 3,4 . Recently, an association of NAFLD with atrial brillation, a non-ischemic cardiac disease, has also been reported 5 . Asthma is the most common chronic airway disease, with approximately 350 million cases reported worldwide in 2015 6 .…”

Section: Introductionmentioning

confidence: 98%

Association Between Nonalcoholic Fatty Liver Disease and the Incidence of Asthma in Adults: Finding from a Nationwide Study in Korea

Roh¹,

Lee²,

Bae³

et al. 2021

Preprint

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Asthma and nonalcoholic fatty liver disease (NAFLD) are chronic diseases and are known to be associated with metabolic abnormalities. We aimed to clarify the association between NAFLD and the incidence of asthma in a large population-based cohort. We selected 160,603 healthy individuals without comorbidities from the National Health Insurance Service-National Sample cohort during 2009–2014. . NAFLD was defined by a surrogate marker, the fatty liver index (FLI). During a median of 5.08 years’ follow-up, 16,377 subjects (10.2%) were newly diagnosed with asthma and categorized into three groups according to FLI. The cumulative incidence of asthma was higher in subjects with higher vs. lower FLIs (FLI < 30 10.1%, 30 ≤ FLI < 60 10.8%, FLI ≥ 60 10.5% ). Higher FLI associated with an increased incidence of asthma (Harzard ratios (HR)highest vs. lowest FLI, 1.25; 95% CI, 1.15-1.36). The results using another definition of NAFLD as measured by hepatic steatosis index (HIS) are similar to the primary results. This association was more pronounced in women than in men (HR 1.46; 95% CI, 1.13-1.64 vs. HR 1.07; 95% CI, 0.94-1.20). This study demonstrated that NAFLD as measured by FLI and HIS may influence the incidence rates of asthma in adults, especially in women.

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Association between non‐alcoholic fatty liver disease and risk of new‐onset atrial fibrillation in healthy adults

Cited by 25 publications

References 25 publications

The risk of atrial fibrillation in patients with non-alcoholic fatty liver disease and a high hepatic fibrosis index

The risk of atrial fibrillation in patients with non-alcoholic fatty liver disease and a high hepatic fibrosis index

Relationship between non-alcoholic fatty liver disease and cardiac arrhythmia: a systematic review and meta-analysis

Association Between Nonalcoholic Fatty Liver Disease and the Incidence of Asthma in Adults: Finding from a Nationwide Study in Korea

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