Section of Endocrinology, Diabetes and Metabolism, Department of Medicine, University and Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy.
Division of Cardiology, ''IRCCS Sacro Cuore - Don Calabria'' Hospital, Negrar (VR), Italy.
Liver Int. 2019 Apr;39(4):758-769. doi: 10.1111/liv.14044. Epub 2019 Feb 7.
BACKGROUND & AIMS: Recent 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.
We 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 modelling.
Nine cross-sectional and longitudinal studies were included in the final analysis (n = 364 919 individuals). Meta-analysis of data from 5 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; I = 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 4 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.
NAFLD is associated with an increased risk of AF in middle-aged and elderly individuals (especially in those with type 2 diabetes). However, the observational design of the eligible studies does not allow for proving causality.
最近的研究检查了非酒精性脂肪性肝病（NAFLD）与成人心房颤动（AF）风险之间的关联，但结果不一致。我们提供了 NAFLD 与 AF 风险之间关联程度的定量估计。
我们使用预定的关键字搜索出版数据库，以确定观察性研究（截至 2018 年 12 月 14 日发表），其中 NAFLD 通过活检、影像学或生物化学诊断，AF 通过病史和心电图诊断。提取选定研究的数据，并使用随机效应模型进行荟萃分析。
最终分析纳入了 9 项横断面和纵向研究（n=364919 人）。对 5 项横断面研究数据的荟萃分析表明，NAFLD 与现患 AF 的风险增加相关（随机效应比值比 2.07，95%CI 1.38-3.10；I=54.7%），独立于年龄、性别、体重指数、高血压和其他常见 AF 危险因素。在患有既定糖尿病的患者中（n=1 项研究；随机效应比值比 5.17，95%CI 2.05-13.02），这种风险尤其高。对 4 项纵向研究数据的荟萃分析表明，仅在 2 型糖尿病患者中，NAFLD 与 10 年 AF 发病风险增加独立相关（n=1 项研究；随机效应风险比 4.96，95%CI 1.42-17.28）。敏感性分析没有改变这些发现。漏斗图未显示出显著的发表偏倚。
NAFLD 与中年和老年人的 AF 风险增加相关（尤其是 2 型糖尿病患者）。然而，合格研究的观察性设计不允许证明因果关系。
