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Association between nonalcoholic fatty liver disease and risk of atrial fibrillation in adults: an updated meta-analysis

Association between nonalcoholic fatty liver disease and risk of atrial fibrillation in adults: an updated meta-analysis
Association between nonalcoholic fatty liver disease and risk of atrial fibrillation in adults: an updated meta-analysis
Background & AimsRecent studies examined the association between non‐alcoholic fatty liver disease (NAFLD) and risk of atrial fibrillation (AF) in adults, but the findings have been inconsistent. We provided a quantitative estimate of the magnitude of the association between NAFLD and risk of AF.MethodsWe searched publication databases using predefined keywords to identify observational studies (published up to December 14, 2018), in which NAFLD was diagnosed by biopsy, imaging or biochemistry, and AF was diagnosed by medical history and electrocardiograms. Data from selected studies were extracted and meta‐analysis was performed using random‐effects modeling.ResultsNine cross‐sectional and longitudinal studies were included in final analysis (n=364,919 individuals). Meta‐analysis of data from five cross‐sectional studies showed that NAFLD was associated with an increased risk of prevalent AF (random‐effects odds ratio 2.07, 95%CI 1.38‐3.10; I2=54.7%), independent of age, sex, body mass index, hypertension and other common AF risk factors. This risk was particularly high among patients with established diabetes (n=1 study; random‐effects odds ratio 5.17, 95%CI 2.05‐13.02). Meta‐analysis of data from four longitudinal studies showed that NAFLD was independently associated with a 10‐year increased risk of incident AF only in type 2 diabetic patients (n=1 study; random‐effects hazard ratio 4.96, 95%CI 1.42‐17.28). Sensitivity analyses did not modify these findings. Funnel plots did not reveal significant publication bias.ConclusionsNAFLD is associated with an increased risk of AF in middle‐aged and elderly individuals (especially with type 2 diabetes). However, the observational design of the eligible studies does not allow for proving causality.
1478-3223
Mantovani, A.
b1382b57-9c74-44b8-8516-c1d82f2eeb2f
Dauriz, M.
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Sandri, D.
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Bonapace, S.
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Zoppini, G.
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Tilg, H.
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Byrne, C.
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Targher, G.
5a842bd2-91c4-4063-b639-da6c681f3698
Mantovani, A.
b1382b57-9c74-44b8-8516-c1d82f2eeb2f
Dauriz, M.
acf9c2ce-e9da-4088-80e2-18acce3bdc83
Sandri, D.
8e4566d9-2294-4077-8e42-d873c5f9efbb
Bonapace, S.
d4e2c2a9-7f06-4c02-b2b4-94e90aa6212d
Zoppini, G.
bad2e82b-1989-4007-84e5-51a6ea765aff
Tilg, H.
741a5191-9a3e-4706-8de6-b68c42c0607e
Byrne, C.
1370b997-cead-4229-83a7-53301ed2a43c
Targher, G.
5a842bd2-91c4-4063-b639-da6c681f3698

Mantovani, A., Dauriz, M., Sandri, D., Bonapace, S., Zoppini, G., Tilg, H., Byrne, C. and Targher, G. (2019) Association between nonalcoholic fatty liver disease and risk of atrial fibrillation in adults: an updated meta-analysis. Liver International. (doi:10.1111/liv.14044).

Record type: Article

Abstract

Background & AimsRecent studies examined the association between non‐alcoholic fatty liver disease (NAFLD) and risk of atrial fibrillation (AF) in adults, but the findings have been inconsistent. We provided a quantitative estimate of the magnitude of the association between NAFLD and risk of AF.MethodsWe searched publication databases using predefined keywords to identify observational studies (published up to December 14, 2018), in which NAFLD was diagnosed by biopsy, imaging or biochemistry, and AF was diagnosed by medical history and electrocardiograms. Data from selected studies were extracted and meta‐analysis was performed using random‐effects modeling.ResultsNine cross‐sectional and longitudinal studies were included in final analysis (n=364,919 individuals). Meta‐analysis of data from five cross‐sectional studies showed that NAFLD was associated with an increased risk of prevalent AF (random‐effects odds ratio 2.07, 95%CI 1.38‐3.10; I2=54.7%), independent of age, sex, body mass index, hypertension and other common AF risk factors. This risk was particularly high among patients with established diabetes (n=1 study; random‐effects odds ratio 5.17, 95%CI 2.05‐13.02). Meta‐analysis of data from four longitudinal studies showed that NAFLD was independently associated with a 10‐year increased risk of incident AF only in type 2 diabetic patients (n=1 study; random‐effects hazard ratio 4.96, 95%CI 1.42‐17.28). Sensitivity analyses did not modify these findings. Funnel plots did not reveal significant publication bias.ConclusionsNAFLD is associated with an increased risk of AF in middle‐aged and elderly individuals (especially with type 2 diabetes). However, the observational design of the eligible studies does not allow for proving causality.

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NAFLD and AF risk meta-analysis Liver Int R1 - Accepted Manuscript
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Supplementary Figure 1 metaregressions - Accepted Manuscript
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Supplementary Figure 2 Funnel plot - Accepted Manuscript
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Figure 1_PRISMA Flowchart - Accepted Manuscript
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Figure 2_Graph_prevalence - Accepted Manuscript
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Figure 3_Graph_incidence - Accepted Manuscript
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Accepted/In Press date: 9 January 2019
e-pub ahead of print date: 18 January 2019

Identifiers

Local EPrints ID: 427443
URI: https://eprints.soton.ac.uk/id/eprint/427443
ISSN: 1478-3223
PURE UUID: a8ac1ab6-d208-400d-b886-9259d671468b
ORCID for C. Byrne: ORCID iD orcid.org/0000-0001-6322-7753

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Date deposited: 16 Jan 2019 17:30
Last modified: 20 Jul 2019 01:09

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Contributors

Author: A. Mantovani
Author: M. Dauriz
Author: D. Sandri
Author: S. Bonapace
Author: G. Zoppini
Author: H. Tilg
Author: C. Byrne ORCID iD
Author: G. Targher

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