| Abstract: | BACKGROUND: Fatty liver disease has become the most prevalent chronic liver disease globally and is linked to cardiovascular disease, including arrhythmias. However, inconsistent findings are published for the association between fatty liver disease and atrial fibrillation and 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 was available in 73.3%, and 7.0% had prevalent atrial fibrillation. Steatosis was not associated with prevalent atrial fibrillation in fully adjusted models (OR:0.80, 95%CI:0.62-1.03), findings were consistent for NAFLD and MAFLD. 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). Last, no associations were found between steatosis (HR: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 to consider assessing cardiovascular health in participants with high liver stiffness, especially in the absence of overt liver disease. LAY SUMMARY: Liver stiffness, and not fatty liver disease, was associated with higher prevalence of atrial fibrillation. Subclinical venous congestion due to atrial fibrillation may drive this association instead of fibrosis. CLINICAL TRIAL NUMBER: NTR6831. |
