Kim Minkwan, Son Minkook, Moon Sang Yi, Baek Yang Hyun
Division of Cardiology, Department of Internal Medicine, Yongin Severance Hospital Yonsei University College of Medicine Yongin Gyeonggi-do Republic of Korea.
Department of Physiology Dong-A University College of Medicine Busan Republic of Korea.
J Am Heart Assoc. 2025 Jul 15;14(14):e042003. doi: 10.1161/JAHA.125.042003. Epub 2025 Jul 14.
The recent reclassification of steatotic liver disease into metabolic dysfunction-associated steatotic liver disease (MASLD) and metabolic dysfunction-associated alcohol-related liver disease has highlighted their potential cardiovascular implications. This study aimed to investigate the impact of MASLD and metabolic dysfunction-associated alcohol-related liver disease on the risk of newly diagnosed atrial fibrillation (AF).
Data from 362 285 participants who underwent a health screening in 2009 to 2010, sourced from the Korean National Health Insurance database, were identified, and we retrospectively analyzed their data through 2019. Excluding those with other liver diseases and heavy alcoholics, 206 455 participants with a fatty liver index were included. The primary outcome was newly diagnosed AF; associated conditions, such as ischemic stroke and heart failure, were also investigated. Participants were classified into 4 groups based on their steatotic liver disease status and alcohol consumption levels.
Over a median follow-up of 9.6 years, 5335 participants were newly diagnosed with AF (2.74 per 1000 person-years). The risk of AF was significantly higher in patients with MASLD who did not consume alcohol (adjusted hazard ratio [aHR], 1.32 [95% CI, 1.23-1.41]; <0.001) and in those with MASLD with alcohol or metabolic dysfunction-associated steatotic liver disease with increased alcohol intake (aHR, 1.48 [95% CI, 1.36-1.61]; <0.001). Compared with all other alcohol consumers, regardless of steatotic liver disease status, nondrinking patients with MASLD had a significantly higher risk of AF (aHR, 1.11 [95% CI, 1.02-1.20]; =0.011).
MASLD is associated with incident AF. These findings suggest that metabolic dysfunction plays a more significant role in AF occurrence than the direct toxic effects of alcohol.
近期脂肪性肝病重新分类为代谢功能障碍相关脂肪性肝病（MASLD）和代谢功能障碍相关酒精性肝病，这凸显了它们对心血管的潜在影响。本研究旨在调查MASLD和代谢功能障碍相关酒精性肝病对新诊断房颤（AF）风险的影响。
从韩国国民健康保险数据库中识别出2009年至2010年接受健康筛查的362285名参与者的数据，并对其2019年之前的数据进行回顾性分析。排除患有其他肝病和重度饮酒者后，纳入206455名有脂肪肝指数的参与者。主要结局是新诊断的房颤；还调查了缺血性中风和心力衰竭等相关疾病。根据参与者的脂肪性肝病状态和饮酒水平将其分为4组。
在中位随访9.6年期间，5335名参与者新诊断为房颤（每1000人年2.74例）。不饮酒的MASLD患者（调整后风险比[aHR]，1.32[95%CI，1.23 - 1.41]；P<0.001）以及饮酒的MASLD患者或酒精摄入量增加的代谢功能障碍相关脂肪性肝病患者中，房颤风险显著更高（aHR，1.48[95%CI，1.36 - 1.61]；P<0.001）。与所有其他饮酒者相比，无论脂肪性肝病状态如何，不饮酒的MASLD患者房颤风险显著更高（aHR，1.11[95%CI，1.02 - 1.20]；P = 0.011）。
MASLD与房颤发生有关。这些发现表明，代谢功能障碍在房颤发生中比酒精的直接毒性作用发挥更重要的作用。
