I Clinica Medica, Atherothrombosis Centre, Department of Internal Medicine and Medical Specialties of Sapienza University of Rome, Italy.
Department of Medical and Surgical Sciences, University Magna Græcia of Catanzaro, Italy.
Mayo Clin Proc. 2020 Mar;95(3):513-520. doi: 10.1016/j.mayocp.2019.08.027. Epub 2019 Nov 18.
To estimate the prevalence of nonalcoholic fatty liver disease (NAFLD) and its impact on bleeding and thrombotic events in patients with atrial fibrillation (AF).
Prospective multicenter cohort study including patients with nonvalvular AF receiving vitamin K antagonists (VKAs) or non-VKA oral anticoagulants (NOACs) from February 2008 for patients on VKA and from September 2013 for patients on NOACs. NAFLD was diagnosed using the validated fatty liver index, with a cutoff score of 60 or higher. Primary end points were the occurrence of major bleedings and cardiovascular events (CVEs).
NAFLD was diagnosed in 732 of 1735 (42.2%) patients. Patients with NAFLD were younger, less frequently women, and more likely to be treated with NOACs and to have obesity, dyslipidemia, and persistent/permanent AF. During a median follow-up of 18.7 months (3155 patient-years), we recorded 78 major bleedings (incidence rate, 2.5% per year): 29 (2.1% per year) in patients with and 49 (2.7% per year) in patients without NAFLD (log-rank test P=.23). Univariate Cox proportional regression analysis showed no association of NAFLD with major bleedings (hazard ratio, 0.75; 95% CI, 0.47-1.20; P=.23). One hundred fifty-five CVEs occurred (incidence rate, 3.1% per year). No significant association was found between NAFLD and CVEs (log-rank test P=.12). In the entire population, NOAC use was associated with lower CVEs compared with VKAs (hazard ratio, 0.61; 95% CI, 0.42-0.89; P=.01).
NAFLD is highly prevalent in AF but is not associated with higher bleeding or thrombotic risk.
评估非酒精性脂肪性肝病（NAFLD）的患病率及其对非瓣膜性心房颤动（AF）患者出血和血栓栓塞事件的影响。
这是一项前瞻性多中心队列研究，纳入 2008 年 2 月起开始接受维生素 K 拮抗剂（VKA）或非维生素 K 拮抗剂口服抗凝剂（NOAC）治疗的非瓣膜性 AF 患者（VKA 组），以及 2013 年 9 月起开始接受 NOAC 治疗的患者（NOAC 组）。采用经验证的脂肪肝指数（FLI）诊断 NAFLD，截断值为 60 或更高。主要终点为主要出血和心血管事件（CVE）的发生。
在 1735 例患者中，732 例（42.2%）被诊断为 NAFLD。患有 NAFLD 的患者年龄较小，女性较少，更可能接受 NOAC 治疗，且更易发生肥胖、血脂异常和持续性/永久性 AF。在中位数为 18.7 个月（3155 患者年）的随访期间，我们记录了 78 例主要出血事件（发生率为每年 2.5%）：在患有 NAFLD 的患者中发生了 29 例（每年 2.1%），在没有 NAFLD 的患者中发生了 49 例（每年 2.7%）（对数秩检验 P=.23）。单因素 Cox 比例风险回归分析显示，NAFLD 与主要出血事件无关（风险比，0.75；95%CI，0.47-1.20；P=.23）。共发生 155 例 CVE（发生率为每年 3.1%）。未发现 NAFLD 与 CVE 之间存在显著相关性（对数秩检验 P=.12）。在整个研究人群中，与 VKA 相比，NOAC 治疗与较低的 CVE 相关（风险比，0.61；95%CI，0.42-0.89；P=.01）。
AF 中 NAFLD 患病率较高，但与更高的出血或血栓形成风险无关。
