A systematic review and meta-analysis of cohort studies on the potential association between NAFLD/MAFLD and risk of incident atrial fibrillation

Ben-Gang Zhou; Sheng-Yong Ju; Yu-Zhou Mei; Xin Jiang; Meng Wang; Ai-Jing Zheng; Yan-Bing Ding

doi:10.3389/fendo.2023.1160532

A systematic review and meta-analysis of cohort studies on the potential association between NAFLD/MAFLD and risk of incident atrial fibrillation

Front Endocrinol (Lausanne). 2023 Jul 5:14:1160532. doi: 10.3389/fendo.2023.1160532. eCollection 2023.

Authors

Ben-Gang Zhou^{1

2}, Sheng-Yong Ju³, Yu-Zhou Mei⁴, Xin Jiang², Meng Wang⁵, Ai-Jing Zheng⁴, Yan-Bing Ding^{1

2}

Affiliations

¹ Dalian Medical University, Dalian, Liaoning, China.
² Department of Gastroenterology, Affiliated Hospital of Yangzhou University, Yangzhou, Jiangsu, China.
³ Medical Department, Affiliated Hospital of Yangzhou University, Yangzhou, Jiangsu, China.
⁴ Department of Gastroenterology, The People's Hospital of China Three Gorges University, Yichang, Hubei, China.
⁵ Department of Neurology, The Third Clinical Medical College of China, Three Gorges University, Gezhouba Central Hospital of Sinopharm, Yichang, Hubei, China.

Abstract

Background and objective: The association between atrial fibrillation (AF) and non-alcoholic fatty liver disease (NAFLD) or metabolic-associated fatty liver disease (MAFLD) has been explored in recent cohort studies, however, the results have been controversial and inconclusive. This meta-analysis aimed to explore this potential association.

Methods: We systematically searched PubMed, Embase, and Web of Science databases to identify all relevant cohort studies investigating the association between NAFLD/MAFLD and AF published from database inception to October 30, 2022. Random-effects models were utilized to calculate hazard ratios (HRs) with 95% confidence intervals (CIs) for summary purposes. Additionally, subgroup and sensitivity analyses were performed.

Results: A total of 13 cohort studies with 14 272 735 participants were included. Among these, 12 cohort studies with 14 213 289 participants (median follow-up of 7.8 years) showed a significant association between NAFLD and an increased risk of incident AF (HR = 1.18, 95% CI: 1.12-1.23, P < 0.00001). Our subgroup analyses mostly yielded similar results, and the results of sensitivity analyses remained unchanged. However, meta-analysis of data from 2 cohort studies with 59 896 participants (median follow-up of 2.15 years) showed that MAFLD was not linked to incident AF (HR = 1.36, 95% CI: 0.63-2.92, P = 0.44).

Conclusion: Current evidence shows that NAFLD may be linked to a slightly higher risk of developing AF, particularly among Asian populations and those diagnosed with NAFLD using FLI criteria. Nevertheless, there is not enough evidence to support the proposed association between MAFLD and an increased risk of AF. To better understand this relationship, future studies should consider factors such as specific population, the severity of NAFLD/MAFLD, diagnostic methods of NAFLD and AF, and cardiometabolic risk factors.

Systematic review registration: https://www.crd.york.ac.uk/prospero, identifier CRD42022371503.

Keywords: atrial fibrillation; cohort studies; meta-analysis; metabolic dysfunction-associated fatty liver disease; non-alcoholic fatty liver disease; systematic review.

Publication types

Meta-Analysis
Systematic Review
Research Support, Non-U.S. Gov't

MeSH terms

Atrial Fibrillation* / epidemiology
Atrial Fibrillation* / etiology
Cardiometabolic Risk Factors
Cohort Studies
Databases, Factual
Humans
Non-alcoholic Fatty Liver Disease* / complications
Non-alcoholic Fatty Liver Disease* / epidemiology

Grants and funding

This work was supported by National Natural Science Foundation of China (No. 82273084), the Strengthening Health Care via Science and Education Project and Clinical Medical Innovation Platform Foundation of Yangzhou (YXZX20184), and the Major Public Health Projects in Yangzhou: Screening projects of early gastrointestinal diseases (2018).