Non-Alcoholic Fatty Liver Disease Is Associated with an Increased Incidence of Atrial Fibrillation in Patients with Type 2 Diabetes

Abstract

BackgroundThe relationship between non-alcoholic fatty liver disease (NAFLD) and atrial fibrillation (AF) in type 2 diabetes is currently unknown. We examined the relationship between NAFLD and risk of incident AF in people with type 2 diabetes.Methods and ResultsWe prospectively followed for 10 years a random sample of 400 patients with type 2 diabetes, who were free from AF at baseline. A standard 12-lead electrocardiogram was undertaken annually and a diagnosis of incident AF was confirmed in affected participants by a single cardiologist. At baseline, NAFLD was defined by ultrasonographic detection of hepatic steatosis in the absence of other liver diseases. During the 10 years of follow-up, there were 42 (10.5%) incident AF cases. NAFLD was associated with an increased risk of incident AF (odds ratio [OR] 4.49, 95% CI 1.6–12.9, p<0.005). Adjustments for age, sex, hypertension and electrocardiographic features (left ventricular hypertrophy and PR interval) did not attenuate the association between NAFLD and incident AF (adjusted-OR 6.38, 95% CI 1.7–24.2, p = 0.005). Further adjustment for variables that were included in the 10-year Framingham Heart Study-derived AF risk score did not appreciably weaken this association. Other independent predictors of AF were older age, longer PR interval and left ventricular hypertrophy.ConclusionsOur results indicate that ultrasound-diagnosed NAFLD is strongly associated with an increased incidence of AF in patients with type 2 diabetes even after adjustment for important clinical risk factors for AF.

Nonalcoholic fatty liver disease is independently associated with early left ventricular diastolic dysfunction in patients with type 2 diabetes

“…Again, no patients were treated with pioglitazone or glucagon-like peptide-1 receptor agonists, which have been shown to reduce hepatic steatosis [1,9,25] and improve cardiac function [26,27]. Finally, our novel finding of a significant association between NAFLD and larger left atrial volume might also be of pathophysiological relevance in the explanation of recent observations documenting that type 2 diabetic patients with NAFLD are at risk of atrial fibrillation [28,29]. Collectively, our results suggest that NAFLD may contribute to impairments of both active and passive LV diastolic properties that are most probably additive to the myocardial defects already present in type 2 diabetes.…”

Non-alcoholic fatty liver disease - the heart of the matter

“…A cohort of 19 NAFLD adults compared to age, gender and BMImatched controls were shown to have a thicker left ventricular wall in both systole and diastole as well as decreased longitudinal shortening than those without fatty liver [50] . One of the consequences of diastolic dysfunction is atrial fibrillation and NAFLD has been shown to have an increased risk (OR = 4.49) of atrial fibrillation which was independent of age, gender, hypertension, and left ventricular hypertrophy and pr interval [51] . Thus adults with NAFLD have changes in cardiac structure and function that may predate overt cardiac artery disease.…”

Age, abdominal obesity, and glycated hemoglobin are associated with carotid atherosclerosis in type 2 diabetes patients with nonalcoholic fatty liver disease

“…However, Targher et al showed that NAFLD was associated with an increased incidence of CVD in T2DM patients, independent of traditional CVD risk factors and MetS components [6]. They also found an increased incidence of atrial fibrillation in NA-FLD-T2DM patients independently of important clinical risk factors for atrial fibrillation [31].…”