Nonalcoholic fatty liver disease as a predictor of atrial fibrillation: a systematic review and meta-analysis

Yaqiong Zhou; Chenglin Lai; Chunrong Peng; Mingyue Chen; Bolin Li; Xiaoyun Wang; Jingjing Sun; Chaofeng Sun

doi:10.5114/aic.2017.70198

Nonalcoholic fatty liver disease as a predictor of atrial fibrillation: a systematic review and meta-analysis

Postepy Kardiol Interwencyjnej. 2017;13(3):250-257. doi: 10.5114/aic.2017.70198. Epub 2017 Sep 25.

Authors

Yaqiong Zhou¹, Chenglin Lai², Chunrong Peng³, Mingyue Chen⁴, Bolin Li¹, Xiaoyun Wang⁵, Jingjing Sun⁶, Chaofeng Sun¹

Affiliations

¹ Department of Cardiology, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi Province, China.
² Department of Endocrinology, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi Province, China.
³ Department of the Obstetrics and Gynecology, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi Province, China.
⁴ Department of Emergency Medicine, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi Province, China.
⁵ Department of Gastroenterology, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi Province, China.
⁶ Intensive Care Unit, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi Province, China.

Abstract

Introduction: Numerous epidemiologic studies have investigated the link between nonalcoholic fatty liver disease (NAFLD) and long-term atrial fibrillation (AF) risk, but the results are surprisingly conflicting.

Aim: Therefore, we systematically reviewed all published studies assessing the risk of AF in patients with NAFLD and conducted a meta-analysis.

Material and methods: We performed a literature search using PubMed, EMBASE and Cochrane Library databases in February 2017 with no restrictions. Two cohort studies and two cross-sectional studies were identified, involving a total of 5150 subjects (NAFLD: 1655; controls: 3495) in this meta-analysis. Data from selected studies were extracted and a meta-analysis was performed using a random effects model.

Results: Nonalcoholic fatty liver disease patients had a significantly higher risk of AF compared to controls (relative risk (RR): 2.61; 95% confidence interval (CI): 1.34-5.06, p = 0.00; I² = 52.5%, p = 0.097). In a further analysis stratified by presence of type 2 diabetes, the increased risk was present predominantly in patients with type 2 diabetes (RR = 5.10; 95% CI: 2.43-10.7, p < 0.001; I² = 0, p = 0.958). However, subjects without type 2 diabetes were at slightly increased risk of AF but the relative risk did not reach statistical significance (RR = 1.68; 95% CI: 0.99-2.82, p = 0.05; I² = 0, p = 0.461).

Conclusions: Our meta-analysis suggested that ultrasound-diagnosed NAFLD patients have a significantly higher risk for AF after adjustment for numerous important clinical risk factors for AF. These results need to be confirmed in large prospective studies.

Keywords: atrial arrhythmia; atrial fibrillation; atrial flutter; nonalcoholic cirrhosis; nonalcoholic fatty liver disease; nonalcoholic steatohepatitis.