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Liver stiffness not fatty liver disease is associated with atrial fibrillation: The Rotterdam study
Laurens A van Kleef1, Zuolin Lu2, M Arfan Ikram2
1Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, The Netherlands.
Insights
Fatty liver disease prevalence did not correlate with atrial fibrillation. However, increased liver stiffness, a marker of liver fibrosis, was linked to a higher prevalence of atrial fibrillation, particularly in those without fatty liver disease.
Area of Science:
- Cardiology
- Hepatology
- Epidemiology
Background:
- Fatty liver disease is the most common chronic liver condition globally.
- It is increasingly recognized as a risk factor for cardiovascular diseases, including arrhythmias like atrial fibrillation.
- The relationship between fatty liver disease and atrial fibrillation, and the role of liver stiffness, remains incompletely understood.
Purpose of the Study:
- To investigate the association between fatty liver disease (steatosis) and liver stiffness with prevalent and incident atrial fibrillation.
- To clarify the role of liver stiffness in the potential link between fatty liver disease and atrial fibrillation.
Main Methods:
- A prospective cohort study (Rotterdam Study) included 5,825 participants assessed between 2009-2014.
- Fatty liver disease was diagnosed via ultrasound, liver stiffness by transient elastography, and atrial fibrillation by electrocardiograms.
- Logistic and Cox-regression models were used to analyze associations with prevalent and incident atrial fibrillation.
Main Results:
- Fatty liver disease was not significantly associated with prevalent or incident atrial fibrillation in adjusted models.
- Liver stiffness showed a significant association with prevalent atrial fibrillation (OR 1.09 per kPa).
- This association between liver stiffness and prevalent atrial fibrillation was more pronounced in participants without fatty liver disease (OR 1.18 per kPa).
Conclusions:
- Fatty liver disease is not independently associated with prevalent or incident atrial fibrillation.
- Increased liver stiffness is associated with a higher prevalence of atrial fibrillation, especially in individuals without fatty liver disease.
- The findings suggest that increased liver stiffness may be a consequence of atrial fibrillation (e.g., due to venous congestion) rather than solely indicative of liver fibrosis, warranting further investigation and cardiovascular risk assessment in such individuals.
Background & Aims:
Fatty liver disease has become the most prevalent chronic liver disease globally and is linked to cardiovascular disease, including arrhythmias. However, there have been inconsistent reports on the association between fatty liver disease and atrial fibrillation, while the role of liver stiffness in this association remains unclear.
Methods:
Within the Rotterdam Study, a large prospective ongoing cohort, participants attending the abdominal ultrasound program between 2009-2014 were included. Exclusion criteria were no atrial fibrillation data or >20% missing data across analysis variables. Steatosis was assessed by ultrasound, liver stiffness by transient elastography and atrial fibrillation by 12-lead electrocardiograms. Incident atrial fibrillation was based on medical records and complete until 2014. Logistic and Cox-regression were used to quantify associations between fatty liver disease and atrial fibrillation.
Results:
We included 5,825 participants (aged 69.5±9.1, 42.9% male), 35.7% had steatosis, liver stiffness measurement was available in 73.3%, and 7.0% had prevalent atrial fibrillation. Steatosis was not associated with prevalent atrial fibrillation in fully adjusted models (odds ratio [OR] 0.80; 95% CI 0.62-1.03), findings were consistent for non-alcoholic or metabolic dysfunction-associated fatty liver disease. Liver stiffness was significantly associated with prevalent atrial fibrillation (OR 1.09 per kPa, 95% CI 1.03-1.16); however, this was only persistent among those without steatosis (OR 1.18 per kPa, 95% CI 1.08-1.29). Lastly, no associations were found between steatosis (hazard ratio 0.88; 95% CI 0.59-1.33; follow-up 2.1 [1.1-3.2] years) and incident atrial fibrillation.
Conclusions:
Fatty liver disease was not associated with prevalent or incident atrial fibrillation, while liver stiffness was significantly associated with atrial fibrillation, especially among those without steatosis. This association might be driven by venous congestion instead of fibrogenesis, but this awaits further validation. We recommend assessing cardiovascular health in participants with high liver stiffness, especially in the absence of overt liver disease.
Clinical Trial Number:
NTR6831.
Lay Summary:
There have been inconsistent reports about the potential links between fatty liver disease and atrial fibrillation (an irregular and often very fast heart rhythm). Herein, we show that liver stiffness (which is a marker of liver fibrosis), but not fatty liver disease, was associated with a higher prevalence of atrial fibrillation. We hypothesis that atrial fibrillation, rather than fibrosis, may be the cause of increased liver stiffness in participants without overt liver disease.
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