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

Abstract

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...

Elevation of Liver Fibrosis Index FIB-4 Is Associated With Poor Clinical Outcomes in Patients With COVID-19

“…FIB-4 is also useful to identify patients with liver diseases who are likely to have a liver-related adverse clinical outcome [17,18]. Importantly, FIB-4 has been shown to predict nonliver-related clinical outcomes like cardiovascular mortality or risk of atrial fibrillation in patients with MAFLD [10,19]. Likewise, FIB-4 has been shown to predict mortality in the general population [20] and clinical outcomes in nonliver-related clinical settings [11].…”

“…Furthermore, patients with advanced fibrosis (stages 3 and 4) present a higher risk of mortality compared with the reference population [7]. However, there is no information related to the prevalence and influence of liver fibrosis in COVID- 19.…”

Pathophysiological mechanisms and clinical evidence of relationship between Nonalcoholic fatty liver disease (NAFLD) and cardiovascular disease

“…In addition, several studies also shown that NAFLD is associated with an increased risk of incident AF, especially among subjects with established T2DM. Park et al [118] observed that individuals with NAFLD and advanced fibrosis had a greater risk of prevalent AF even after adjusting for multiple CVD risk factors. The presence and severity of NAFLD is associated with a higher risk for corrected QT (QTc) interval prolongation resulting in an increased risk of both ventricular tachyarrhythmias and sudden cardiac death [90].…”

Required warfarin dose and time in therapeutic range in patients with diagnosed Nonalcoholic Fatty Liver Disease (NAFLD) or Nonalcoholic Steatohepatitis (NASH)

“…Moreover, procoagulant imbalance may occur in patients with NAFLD/NASH [23]. Previous studies have demonstrated that NAFLD/NASH is independently associated with an increased risk of atrial fibrillation (AF) in adults and elderlies, especially those with type 2 diabetes mellitus (T2DM) [24,25]. Evidence also suggest a higher rate of unprovoked venous thromboembolism (VTE) in patients with NAFLD/NASH [26][27][28].…”