Non-alcoholic Fatty Liver Disease and the Risk of Incident Atrial Fibrillation in Young Adults: A Nationwide Population-Based Cohort Study

Abstract

BackgroundNon-alcoholic fatty liver disease (NAFLD) is a multisystem disease including cardiovascular. However, the association between NAFLD and the risk of incident atrial fibrillation (AF), especially in young adults, remains unclear. We aimed to evaluate the association between NAFLD as assessed by the fatty liver index (FLI) and the risk of AF in young adults.MethodsWe identified individuals aged 20–39 years who underwent health examinations conducted by the Korean National Health Insurance Corporation between January 2009 and December 2012. Individuals with significant liver disease, heavy alcohol consumption, or prevalent AF were excluded. We categorized based on FLI: <30, 30 to <60, and ≥60. Incident AF was evaluated as the primary outcome.ResultsWe included 5,333,907 subjects (mean age, 31 ± 5 years; men, 57%). During a mean follow-up of 7.4 ± 1.1 years, 12,096 patients had newly diagnosed AF (incidence rate 0.31 per 1,000 person-years). After adjustment, subjects with FLI 30 to <60 and FLI ≥60 showed a higher risk of AF compared to those with FLI <30 (hazard ratio [HR] 1.21, 95% confidence interval [CI, 1.15–1.27] and HR 1.47, 95% CI [1.39–1.55], p < 0.001, respectively). In women, the increased AF risk was accentuated in the higher FLI group than in the individuals with FLI <30, compared with men (p-for-interaction = 0.023). A higher incident AF risk in the higher FLI groups was consistently observed in various subgroups.ConclusionAmong young adults, NAFLD assessed using FLI was positively correlated with the AF risk. These findings support the evidence of AF screening in young adults with high FLI scores.

Association between nonalcoholic fatty liver disease and atrial fibrillation and other clinical outcomes: a meta-analysis

“…30 Similarly, a correlation was found wherein increased AF risk was more pronounced if patients had a higher fibrosis-4 index score even after adjusting for traditional risk factors of atherosclerosis such as coronary heart disease. 35,36 Though the incidence of stroke is proportionally higher in AF and may be tightly linked to adverse stroke events, a previous Chinese cohort study of 79,905 patients confirms our results indicating that NAFLD independently increases the risk of cerebrovascular complications after adjusting for confounding variables. 15 The EUROSTROKE case-control study also found that elevations in gGT, a sensitive marker for NAFLD, were strongly associated with stroke risk without T2DM or established CVD history.…”

Non-alcoholic fatty liver disease increases the risk of cardiovascular disease in young adults and children: a systematic review and meta-analysis of cohort studies

“…The publication period ranges from 2020 to 2023. In South Korea, two studies ( 22 , 23 ) were carried out, while in Germany ( 20 ) and Switzerland ( 24 ), one study each was conducted. Three studies ( 21 – 23 ) were conducted on young adults in the age range of 18–40, and one study ( 24 ) investigated children and young people aged ≤ 25 years (mean age: 17 years).…”

“…Three studies ( 21 – 23 ) were conducted on young adults in the age range of 18–40, and one study ( 24 ) investigated children and young people aged ≤ 25 years (mean age: 17 years). Regarding definition of NAFLD, two studies ( 22 , 23 ) used fatty liver index, one ( 24 ) used liver biopsy, and one ( 21 ) used international classification of diseases codes. Three studies reported data on AF and stroke, two on CHD and MI, and one on congestive heart failure (CHF).…”

“…The average length of the follow-up period was between 7.4 and 16.6 years. The two studies ( 21 , 24 ) that were given nine stars were rated as having high quality, while the other two ( 22 , 23 ) were given eight stars, signifying moderate quality. A detailed analysis of the methodological quality of the studies included in the NOS is provided in the Supplementary Table S3 available on the web.…”

High liver fibrosis scores in metabolic dysfunction-associated fatty liver disease patients are associated with adverse atrial remodeling and atrial fibrillation recurrence following catheter ablation

“…Although the liver–heart interaction is well described in the context of atherosclerosis ( 8 ) and ventricular remodeling ( 9 ), only sparse data explored the association between atrial pathology and MAFLD ( 9 – 11 ). A limited number of epidemiological studies have shown an independent association between MAFLD and the incidence of atrial fibrillation (AF) ( 12 – 14 ); however, the pathogenesis leading to AF in the context of MAFLD remains unclear.…”