With increasing evidence showing an association between liver disease and cardiovascular complications, researchers sought to establish the role of MASLD and alcoholic variants to incident atrial fibrillation. From 362,285 individuals who had undergone health examinations between 2009 and 2010, researchers undertook a retrospective study up to 2019 from the Korean National Health Insurance database. After the exclusion of those with other liver disease and heavy drinkers, 206,455 participants with a fatty liver index were analyzed in the final model.
Participants were grouped into four groups according to steatotic liver disease status and alcohol use behaviors. The main endpoint was new atrial fibrillation diagnosis, with ischemic stroke and heart failure additionally considered as related outcomes.
Key Findings
• During a median follow-up duration of 9.6 years, new-onset atrial fibrillation occurred in 5,335 participants, that is, 2.74 cases per 1,000 person-years.
• MASLD without alcohol was characterized by a 32% higher risk for AF (adjusted hazard ratio [aHR], 1.32; 95% CI, 1.23–1.41; P<0.001).
• MASLD with alcohol or metabolic dysfunction–associated steatotic liver disease with greater alcohol use demonstrated a 48% increased risk of AF (aHR, 1.48; 95% CI, 1.36–1.61; P<0.001).
• Among all subjects, nondrinking MASLD patients had a higher risk of AF by 11% compared with other drinkers, independent of their disease status (aHR, 1.11; 95% CI, 1.02–1.20; P=0.011).
This research verified that metabolic dysfunction-associated steatotic liver disease even without alcohol consumption, considerably elevates the risk of atrial fibrillation. The findings emphasize the relevance of identifying MASLD as an independent cardiovascular risk factor and necessitate active management of metabolic well-being to avert AF. Physicians ought not to disregard the cardiovascular significance of liver disease, especially for those with signs of metabolic syndrome.
Reference:
Kim, M., Son, M., Moon, S. Y., & Baek, Y. H. (2025). Metabolic dysfunction-associated steatotic liver disease, alcohol consumption, and the risk of atrial fibrillation: A nationwide population-based study. Journal of the American Heart Association, 14(14), e042003. https://doi.org/10.1161/JAHA.125.042003
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