MASLD is associated with an increased long-term risk of atrial fibrillation: an updated systematic review and meta-analysis
MASLD is associated with an increased long-term risk of atrial fibrillation: an updated systematic review and meta-analysis
Background: studies have reported an association between metabolic dysfunction-associated steatotic liver disease (MASLD) and an increased risk of developing atrial fibrillation (AF). However, the magnitude of the risk and whether this risk varies with the severity of MASLD remains uncertain.
Methods: in this systematic review and meta-analysis, we searched three large electronic databases using predefined keywords to identify cohort studies (published up to 30 September 2024) in which MASLD was diagnosed by liver biopsy, imaging methods, International Classification of Diseases (ICD) codes, or blood-based scores. The primary outcome was the occurrence of AF based on ICD codes, medical records, or electrocardiograms. Meta-analysis was performed using random-effects modelling.
Results: we identified 16 retrospective cohort studies with aggregate data on ~19.5 million individuals followed for a median of 7.2 years. MASLD was significantly associated with an increased risk of developing incident AF (random-effects hazard ratio 1.20, 95% CI 1.10–1.32; I2 = 92%). This risk did not appear to further increase with the severity of liver fibrosis (n = 3 studies; random-effects hazard ratio 1.22, 95% CI 1.18–1.26; I2 = 10%). The risk of AF remained significant even after adjusting for age, sex, body mass index, hypertension, Type 2 diabetes or other cardiometabolic risk factors. Sensitivity analyses did not modify these findings. The funnel plot and Egger's test showed no significant publication bias.
Conclusions: this updated and comprehensive meta-analysis provides evidence that MASLD is significantly associated with an increased long-term risk of developing incident AF. Further research is required to better decipher the link between MASLD and increased AF incidence.
MASLD, NAFLD, arrhythmias, atrial fibrillation, metabolic dysfunction-associated steatotic liver disease, non-alcoholic fatty liver disease
e16128
Mantovani, Alessandro
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Morandin, Riccardo
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Sani, Elena
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Fiorio, Veronica
da165672-fa18-42da-bde4-387026568ea6
Shtembari, Emigela
e6edfd9d-0ba9-4242-ac94-e956745f5bf6
Bonapace, Stefano
8ee636f9-2235-4dd2-a6a8-5b7933631670
Petta, Salvatore
d3bc7846-191c-4c6d-a733-442041919b4e
Polyzos, Stergios A.
ada5cded-65d9-41d3-ab51-12cb039a480b
Byrne, Christopher D.
1370b997-cead-4229-83a7-53301ed2a43c
Targher, Giovanni
fe131a69-4699-4a39-a2bc-051447a8381f
1 January 2025
Mantovani, Alessandro
db41e0b4-773a-4a89-b8a1-9135ca9c959c
Morandin, Riccardo
f72847cf-9d21-4946-b782-534ba06b8ed8
Sani, Elena
ce844c15-c097-4bb1-9b92-3d1044498e99
Fiorio, Veronica
da165672-fa18-42da-bde4-387026568ea6
Shtembari, Emigela
e6edfd9d-0ba9-4242-ac94-e956745f5bf6
Bonapace, Stefano
8ee636f9-2235-4dd2-a6a8-5b7933631670
Petta, Salvatore
d3bc7846-191c-4c6d-a733-442041919b4e
Polyzos, Stergios A.
ada5cded-65d9-41d3-ab51-12cb039a480b
Byrne, Christopher D.
1370b997-cead-4229-83a7-53301ed2a43c
Targher, Giovanni
fe131a69-4699-4a39-a2bc-051447a8381f
Mantovani, Alessandro, Morandin, Riccardo, Sani, Elena, Fiorio, Veronica, Shtembari, Emigela, Bonapace, Stefano, Petta, Salvatore, Polyzos, Stergios A., Byrne, Christopher D. and Targher, Giovanni
(2025)
MASLD is associated with an increased long-term risk of atrial fibrillation: an updated systematic review and meta-analysis.
Liver International, 45 (1), , [e16128].
(doi:10.1111/liv.16218).
Abstract
Background: studies have reported an association between metabolic dysfunction-associated steatotic liver disease (MASLD) and an increased risk of developing atrial fibrillation (AF). However, the magnitude of the risk and whether this risk varies with the severity of MASLD remains uncertain.
Methods: in this systematic review and meta-analysis, we searched three large electronic databases using predefined keywords to identify cohort studies (published up to 30 September 2024) in which MASLD was diagnosed by liver biopsy, imaging methods, International Classification of Diseases (ICD) codes, or blood-based scores. The primary outcome was the occurrence of AF based on ICD codes, medical records, or electrocardiograms. Meta-analysis was performed using random-effects modelling.
Results: we identified 16 retrospective cohort studies with aggregate data on ~19.5 million individuals followed for a median of 7.2 years. MASLD was significantly associated with an increased risk of developing incident AF (random-effects hazard ratio 1.20, 95% CI 1.10–1.32; I2 = 92%). This risk did not appear to further increase with the severity of liver fibrosis (n = 3 studies; random-effects hazard ratio 1.22, 95% CI 1.18–1.26; I2 = 10%). The risk of AF remained significant even after adjusting for age, sex, body mass index, hypertension, Type 2 diabetes or other cardiometabolic risk factors. Sensitivity analyses did not modify these findings. The funnel plot and Egger's test showed no significant publication bias.
Conclusions: this updated and comprehensive meta-analysis provides evidence that MASLD is significantly associated with an increased long-term risk of developing incident AF. Further research is required to better decipher the link between MASLD and increased AF incidence.
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More information
Accepted/In Press date: 4 December 2024
e-pub ahead of print date: 25 December 2024
Published date: 1 January 2025
Keywords:
MASLD, NAFLD, arrhythmias, atrial fibrillation, metabolic dysfunction-associated steatotic liver disease, non-alcoholic fatty liver disease
Identifiers
Local EPrints ID: 497559
URI: http://eprints.soton.ac.uk/id/eprint/497559
ISSN: 1478-3223
PURE UUID: 425d4dde-1989-48a0-8506-b057ad1b9f17
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Date deposited: 27 Jan 2025 17:58
Last modified: 22 Aug 2025 01:45
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Contributors
Author:
Alessandro Mantovani
Author:
Riccardo Morandin
Author:
Elena Sani
Author:
Veronica Fiorio
Author:
Emigela Shtembari
Author:
Stefano Bonapace
Author:
Salvatore Petta
Author:
Stergios A. Polyzos
Author:
Giovanni Targher
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