Association between non‐alcoholic fatty liver disease and risk of atrial fibrillation in adult individuals: An updated meta‐analysis

Mantovani, Alessandro; Dauriz, Marco; Sandri, Damiano; Bonapace, Stefano; Zoppini, Giacomo; Tilg, Herbert; Byrne, Christopher D.; Targher, Giovanni

doi:10.1111/liv.14044

Cited by 94 publications

(102 citation statements)

References 49 publications

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“…Thirdly, we found an increased risk of developing cardiac arrhythmias such as AF and ventricular arrhythmias in NAFLD patients. The recent meta-analysis by Mantovani et al [38] involving 9 cross-sectional and longitudinal studies with a study sample of 364,919 subjects concluded that NAFLD was associated with an increased risk of AF in middle-aged and elderly subjects especially type 2 diabetics. Another meta-analysis assessing the relationship between NAFLD and AF conducted by Wijarnpreecha et al [39] involving 5 studies out of which 2 were cross-sectional studies and 3 were cohort studies with 238,129 participants concluded that NAFLD patients were at a significantly increased risk for developing AF compared to subjects without NAFLD.…”

Section: Discussionmentioning

confidence: 99%

Cardiac Arrhythmias and Electrocardiogram Modifications in Non-Alcoholic Fatty Liver Disease. A Systematic Review

Ismaiel

Colosi

Rusu

et al. 2019

JGLD

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Background and Aims: Recent studies have evaluated the relationship associating non-alcoholic fatty liver disease (NAFLD) with several electrocardiogram (ECG) findings, but the results have been inconsistent. The aim of this systematic review is to assess the association between NAFLD with ECG modifications. Methods: We conducted a systematic search on PubMed with predefined keywords identifying observational studies published till 22 February 2019 with NAFLD diagnosed either by biopsy, imaging, surrogate markers or ICD code and ECG findings by either a standard ECG, 24-hour Holter ECG or ICD code. Quality assessment was performed using the quality assessment tools from the National Heart, Lung, and Blood Institute. Results: A total of 20 observational studies (1 case-control, 4 cohort, 15 cross-sectional studies, 401,745 individuals) were included. Twelve studies evaluated cardiac arrhythmias in NAFLD subjects, out of which 10 evaluated atrial fibrillation (AF). Although results were inconsistent, most studies rated as “good” demonstrated that hepatic steatosis was independently associated with an increased risk for prevalent AF in NAFLD patients. Diabetic patients with NAFLD were associated with an increased risk of ventricular arrhythmias in only one study rated as “good”. Two studies rated as “good” demonstrated that hepatic steatosis was associated with a prolonged QTc interval. Four studies supported the association between cardiac conduction abnormalities and NAFLD, out of which two were rated as “good”. Two studies assessed ECG modifications of ischemic heart disease (IHD), but only one having a “good” rating confirmed this independent association. Conclusions: Studies of high quality and with low risk of bias demonstrated that NAFLD is independently associated with AF, a prolonged QTc interval, bundle branch and atrioventricular blocks. Diabetic patients with NAFLD present an increased risk for developing ventricular arrhythmias.

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Section: Discussionmentioning

confidence: 99%

Cardiac Arrhythmias and Electrocardiogram Modifications in Non-Alcoholic Fatty Liver Disease. A Systematic Review

Ismaiel

Colosi

Rusu

et al. 2019

JGLD

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“…In addition, advancing age and increasing trends in risk factors in the US population may contribute to increased AF incidence and prevalence . AF and liver disease shared several common risk factors, resulting in more frequent presentation of AF in ELSD patients . This study also showed that risk factors for AF including hypertension, obesity, diabetes, dyslipidaemia, prior stroke and coronary artery disease in ESLD have increased over the period.…”

Section: Discussionmentioning

confidence: 57%

“…33 AF and liver disease shared several common risk factors, resulting in more frequent presentation of AF in ELSD patients. 36,37 This study also showed that risk factors for AF including hypertension, obesity, diabetes, dyslipidaemia, prior stroke and coronary artery disease in ESLD have increased over the period. Lastly, declining AF-related mortality in ESLD may also link to the increased AF prevalence.…”

Section: Discussionmentioning

confidence: 59%

Atrial fibrillation in hospitalized patients with end‐stage liver disease: temporal trends in prevalence and outcomes

Han

Qin

et al. 2019

Liver International

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Background & Aims End‐stage liver disease (ESLD) happens due to the development and progression of chronic liver disease. This study aims to investigate the temporal trend, patient characteristics and outcomes of atrial fibrillation (AF) in hospitalized ESLD patients across the United States. Methods Nationwide Inpatient Sample from 2003 to 2014 was utilized to retrospectively study the weighted prevalence of AF in hospitalized ESLD patients. Multivariable regression models were used to assess the association between AF with clinical factors, in‐hospital mortality, length of stay (LOS) and cost. Results 639 345 hospitalizations associated with ESLD were identified, of which 47 710 (7.48%) were diagnosed with AF. The prevalence of AF increased from 5.73% in 2003 to 9.75% in 2014 in ESLD and varied by age, race, income, insurance type and hospital characteristics. Factors associated with AF included advancing age, male, white race, high income and urban teaching hospital. AF presence was associated with significant higher in‐hospital mortality (odds ratio, 1.40; 95% confidence interval, 1.35‐1.45), 21% longer LOS and 22% higher cost. In addition, a significant decreasing trend in in‐hospital mortality was observed (from 16.70% to 10.63% in patients with AF and from 10.74% to 7.50% in patients without AF). Conclusions The prevalence of AF in hospitalized ESLD patients has continued to increase from 2003 through 2014. AF is associated with poor prognosis and higher health resource utilization. Innovative anticoagulation strategies through improved collaboration between cardiologists and hepatologists are required for better management of hospitalized ESLD patients comorbid with AF.

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“…Interestingly, several observational studies reported an association between NAFLD and increased risk of AF in patients with and without T2D, after adjustment for multiple potential confounders [46]. A recent metanalysis showed that NAFLD was independently associated with increased risk of prevalent (OR 2.07) and, only in T2D patients, incident [hazard ratio (HR) 4.96] AF [47]. Studies investigating whether the reversal of NAFLD will reduce the risk of AF are eagerly awaited.…”

Section: Af and Vte In The Nafld Spectrummentioning

confidence: 99%

Direct Oral Anticoagulants in Patients with Liver Disease in the Era of Non-Alcoholic Fatty Liver Disease Global Epidemic: A Narrative Review

Ballestri¹,

Capitelli²,

Fontana³

et al. 2020

Adv Ther

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Atrial fibrillation (AF) and venous thromboembolism (VTE) are highly prevalent and relevant healthcare issues. Direct oral anticoagulants (DOACs) are now the first-choice for anticoagulant treatment of these conditions displaying a better efficacy/safety profile than vitamin-K antagonists, mainly due to significantly reduced risk of major bleeding, especially of intracranial haemorrhage. Nonalcoholic fatty liver disease (NAFLD) is the most common liver disease in developed countries showing a continuously growing prevalence. Nonalcoholic steatohepatitis (NASH), its evolutive form, will be the leading cause for liver transplantation by 2020. NAFLD is independently associated with an increased risk of abnormalities of cardiac structure and function, including cardiac rhythm disorders (mainly AF). Moreover, data suggest an increased risk of unprovoked VTE associated with NAFLD/NASH. Therefore, a growing number of patients with chronic liver disease (CLD) will be candidate for anticoagulant therapy in the near future. Cirrhosis of any etiology is characterized by an unstable thrombosis/bleeding haemostatic balance, making anticoagulant therapy particularly challenging in this condition. Given that patients with significant active liver disease and cirrhosis were excluded from all pivotal randomized controlled trials on DOACs, this comprehensive review aims at critically discussing real-world evidence, including the latest population studies, regarding the use of DOACs in patients with CLD/cirrhosis.

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Association between non‐alcoholic fatty liver disease and risk of atrial fibrillation in adult individuals: An updated meta‐analysis

Cited by 94 publications

References 49 publications

Cardiac Arrhythmias and Electrocardiogram Modifications in Non-Alcoholic Fatty Liver Disease. A Systematic Review

Cardiac Arrhythmias and Electrocardiogram Modifications in Non-Alcoholic Fatty Liver Disease. A Systematic Review

Atrial fibrillation in hospitalized patients with end‐stage liver disease: temporal trends in prevalence and outcomes

Direct Oral Anticoagulants in Patients with Liver Disease in the Era of Non-Alcoholic Fatty Liver Disease Global Epidemic: A Narrative Review

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