What is the clinical evidence from this study?

Study design: Cohort. Population: Nonalcoholic fatty liver disease (NAFLD) (n=3179582). Intervention: Nonalcoholic fatty liver disease (NAFLD) with advanced fibrosis vs. No NAFLD. Primary outcome: Incident atrial fibrillation (HR 1.627, 95% CI 1.586-1.670).

September 12, 2024Cardiovascular Diabetology13 citationsOpen Access

Association of nonalcoholic fatty liver disease with new-onset atrial fibrillation stratified by age groups

ECEun Ju Cho GCGoh Eun Chung JYJeong‐Ju Yoo

Key Result

Grade 2 nonalcoholic fatty liver disease with advanced fibrosis was associated with a significantly increased risk of new-onset atrial fibrillation compared to no NAFLD (HR 1.627).

Study Design

Type

Cohort (n=3,179,582)

Structured PICO

Does nonalcoholic fatty liver disease and its severity increase the risk of new-onset atrial fibrillation across different age groups?

Population

3,179,582 Korean adults aged 20 years and older, free of prior atrial fibrillation and obvious liver disease, followed for a median of 9.3 years.

Exposure

Nonalcoholic fatty liver disease (NAFLD) categorized by severity (grade 1 or 2) and presence of advanced fibrosis (BARD score ≥ 2)

Comparator

No NAFLD (fatty liver index [FLI] < 30)

Outcome

Incident atrial fibrillationhard clinical

Nonalcoholic fatty liver disease, particularly with advanced fibrosis, is independently associated with an increased risk of new-onset atrial fibrillation, even in younger adults.

Main Result

Hazard Ratio: 1.627 (95% CI 1.586–1.67)

Absolute Event Rate: 4.09% vs 1.75%

Limitations

The fatty liver index (FLI) has limited accuracy in quantifying hepatic steatosis and differentiating simple steatosis from steatohepatitis.
The BARD score has high false positivity and is less specific compared to other biomarkers.
Unmeasured confounders, such as inflammation or insulin resistance, could have influenced the results.
The cross-sectional design limits establishing a cause-and-effect relationship.
The study population comprised participants from a single country, which may limit generalizability to other ethnic groups.

Abstract

BACKGROUND: The association between nonalcoholic fatty liver disease (NAFLD) and atrial fibrillation (AF) has been inconsistent, and the impact of hepatic fibrosis on this relationship remains uncertain. We investigated the association between NAFLD and the risk of new-onset AF across different age groups. METHODS: A total of 3,179,582 participants from the 2009 Korean National Health Screening Program were divided into five groups based on NAFLD status: no NAFLD (fatty liver index FLI < 30); grade 1 NAFLD without advanced fibrosis (FLI 30-59 grade 1 NAFLD with advanced fibrosis (FLI 30-59 grade 2 NAFLD without advanced fibrosis (FLI ≥ 60 and grade 2 NAFLD with advanced fibrosis (FLI ≥ 60 grade 1 NAFLD with advanced fibrosis (HR 1.275, 95% CI 1.251-1.300); grade 2 NAFLD without advanced fibrosis (HR 1.305, 95% CI: 1.252-1.360); and grade 2 NAFLD with advanced fibrosis (HR 1.627, 95% CI: 1.586-1.670). In the multivariate model, the excess risk of AF in patients with NAFLD and advanced fibrosis remained significant, even in participants aged 20-39 years. CONCLUSION: Patients with NAFLD had a higher risk of new-onset AF, which increased progressively with NAFLD severity, particularly in those aged 20-29 years.

Ask AI

Helpful

Bookmark

View Full Paper