Non-alcoholic fatty liver disease is associated with an increased prevalence of atrial fibrillation in hospitalized patients with Type 2 diabetes

Abstract

NAFLD (non-alcoholic fatty liver disease) and AF (atrial fibrillation) are two pathological conditions that are highly prevalent in developed countries and share multiple risk factors. The relationship between NAFLD and AF in Type 2 diabetes is currently unknown. We studied a hospital-based sample of 702 patients with Type 2 diabetes discharged from our Division of Endocrinology during 2007-2011. The diagnosis of AF was confirmed in affected participants on the basis of ECGs and medical history by experienced cardiologists. NAFLD was defined by ultrasonographic detection of hepatic steatosis in the absence of other liver diseases. Of the 702 hospitalized patients included in the study, 514 (73.2%) of them had NAFLD and 85 (12.1%) had persistent or permanent AF. NAFLD was associated with an increased risk of prevalent AF {OR (odds ratio), 3.04 [95% CI (confidence interval), 1.54-6.02]; P<0.001}. Adjustments for age, sex, systolic BP (blood pressure), HbA1c, (glycated haemoglobin), estimated GFR (glomerular filtration rate), total cholesterol, electrocardiographic LVH (left ventricular hypertrophy), COPD (chronic obstructive pulmonary disease), and prior history of HF (heart failure), VHD (valvular heart disease) or hyperthyroidism did not attenuate the association between NAFLD and AF [adjusted OR, 5.88 (95% CI, 2.72-12.7); P<0.001]. In conclusion, our results show that ultrasound-diagnosed NAFLD is strongly associated with an increased prevalence of persistent or permanent AF in patients with Type 2 diabetes, independently of several clinical risk factors for AF. The potential impact of NAFLD on AF deserves particular attention, especially with respect to the implications for screening and surveillance strategies in the growing number of patients with NAFLD.

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.…”

Gamma-glutamyl transferase and cardiovascular disease

“…Not surprisingly, the adjustment for fatty liver has attenuated the association between GGT and CVD mortality (58). Nonalcoholic fatty liver disease is associated with the risk of ventricular arrhythmias (85) and atrial fibrillation (86). In particular, elevated GGT is associated with the increased risk for atrial fibrillation either because both conditions share similar risk factors or because of ectopic fat accumulation in atrial myocardium (87) which may modulate the electrophysiological properties and ion currents predisposing for arrhythmogenesis (88).…”

Circulating phospholipid profiling identifies portal contribution to NASH signature in obesity

“…NAFLD is associated with elevated cardiovascular risk [8] [9][10] with increased fat mass as an important mediator. We showed that accumulation of inflammatory cells in visceral and not subcutaneous adipose tissue is associated with severity of NAFLD in morbid obesity [11] [12].…”