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. 2024 Sep 12;23(1):340.
doi: 10.1186/s12933-024-02408-7.

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

Eun Ju Cho #  1 , Goh Eun Chung #  1   2 , Jeong-Ju Yoo  3 , Yuri Cho  4 , Kyu Na Lee  5 , Dong Wook Shin  6   7 , Yoon Jun Kim  1 , Jung-Hwan Yoon  1 , Kyungdo Han #  8 , Su Jong Yu #  9
Affiliations

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

Eun Ju Cho et al. Cardiovasc Diabetol. .

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 & BARD < 2); grade 1 NAFLD with advanced fibrosis (FLI 30-59 & BARD ≥ 2); grade 2 NAFLD without advanced fibrosis (FLI ≥ 60 & BARD < 2); and grade 2 NAFLD with advanced fibrosis (FLI ≥ 60 & BARD ≥ 2). The primary outcome was incident AF.

Results: During the median follow-up of 9.3 years, 62,542 patients were diagnosed with new-onset AF. In the age- and sex-adjusted model, the risk of new-onset AF increased across NAFLD grades and fibrosis categories: grade 1 NAFLD without advanced fibrosis (hazard ratio [HR] 1.120, 95% confidence interval [CI]: 1.081-1.161); 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.

Keywords: Atrial fibrillation; Fatty liver index; Severity; Steatosis.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Flow chart of the study population
Fig. 2
Fig. 2
The association of nonalcoholic fatty liver disease severity with new-onset atrial fibrillation stratified by age groups Adjusted for age, sex, income levels, body mass index, lifestyle factors (smoking status, alcohol consumption, physical activity), diabetes mellitus hypertension, dyslipidemia, and chronic kidney disease. BMI body mass index, CI confidence interval
Fig. 3
Fig. 3
Stratified analysis by various groups Adjusted for age, sex, income levels, body mass index, lifestyle factors (smoking status, alcohol consumption, physical activity), diabetes mellitus hypertension, dyslipidemia, and chronic kidney disease. BMI body mass index, HR hazard ratio, CI confidence interval
See this image and copyright information in PMC

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