Sudden cardiac death associated with fatty liver disease

Fatty liver disease or steatotic liver disease (SLD) affects 25% of the global population and has been associated with heart disease. However, there is a lack of postmortem studies in the context of sudden cardiac death (SCD).

To investigate the relationship between SLD and SCD.

A post-mortem case-case study was conducted in victims of SCD from an ongoing community-based study in Southern California (Ventura, CA, 2015-2023). Diagnosis of SLD was determined from post-mortem liver histopathology reports. For each patient, demographic variables, laboratory values, and presence of co-morbidities were ascertained from medical records and were compared between patients with and without SLD.

Of 162 individuals with SCD, there were 101 SLD cases and 61 without SLD. Individuals with SLD were found to have higher BMI (31.6 ± 7.6 vs. 26.7 ± 5.7, p < 0.001), higher prevalence of heavy drinking (28 % vs. 12 %, p = 0.008), heavier liver weights (2433.6 g ± 940.6 vs 1934.7 g ± 505.3, p < 0.001), and were more often Hispanic (37 vs. 18 %, p = 0.01). Patients with SLD had lower prevalence of coronary artery disease (CAD) (49 % vs. 70 %). Multivariable logistic regression analysis showed that CAD was a negative predictor of SCD with SLD (OR = 0.35, 95 % CI 0.14 - 0.83).

Among adults with SCD, SLD was associated with higher prevalence of Hispanic ethnicity and lower prevalence of CAD. Given the major rise in SLD burden, these ethnicity-based differences as well as the specific nature of non-ischemic SCD etiologies warrant urgent further investigation.