Metabolic dysfunction-associated steatotic liver disease and the longitudinal progression of atrial fibrillation: a...

Atrial fibrillation (AF) frequently coexists with other complications, including myocardial infarction (MI), heart failure (HF), stroke, and dementia. The contribution of metabolic dysfunction-associated steatotic liver disease (MASLD) to the development and mortality of AF was under-recognized. This study aims to investigate the impact of MASLD on the progression of AF and the mediating effect of carotid intima-media thickness (cIMT).

Multistate analysis was conducted to investigate the associations of MASLD with the progression from health to AF, further AF-related complications, and ultimately death. Counterfactual mediation analysis was employed to quantify the extent to which cIMT explained the associations of MASLD with AF, AF-related complications, and death. As many as 350,745 participants were followed for a median of 13.67 (IQR = 12.94 to 14.38) years. Among them, 21,240 (6.06 %) participants experienced AF, 5,808 (27.34 %) developed AF-related complications, afterwards, 1,854 (31.92 %) were died. Compared with non-MASLD, MASLD patients exhibited a higher risk of transitions from health to AF, then to AF-related complications, particularly transition from health to AF, with HR was 1.52 (95 % CI: 1.48-1.57). The proportion mediated by cIMT for AF, AF-related complications, and mortality were 16.51 %, 18.06 %, and 15.14 %, respectively.

Our study revealed that MASLD heightened the risk of the longitudinal advancement of AF, with cIMT recognized as a crucial mediator. This highlights the significance of managing MASLD patients and monitoring atherosclerosis for the subclinical prevention of AF progression.