Park Jeayeon, Chung Goh Eun, Yu Su Jong, Kim Yoon Jun, Yoon Jung-Hwan, Han Kyungdo, Cho Eun Ju
Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea.
Department of Internal Medicine and Healthcare Research Institute, Seoul National University Hospital Healthcare System Gangnam Center, Seoul, Republic of Korea.
Cardiovasc Diabetol. 2025 Aug 25;24(1):348. doi: 10.1186/s12933-025-02905-3.
BACKGROUND/AIM: Metabolic dysfunction is emerging as a significant risk factor for atrial fibrillation (AF) and serves as a foundational component of both metabolic dysfunction-associated steatotic liver disease (MASLD) and MASLD with moderate alcohol intake (MetALD). As the prevalence of steatotic liver disease (SLD) rises among young adults, clarifying its association with AF in this population has become a clinical priority. Accordingly, we aimed to investigate the link between different SLD subtypes and the risk of incident AF in young adults.
In this nationwide cohort study, we analyzed data from the Korean National Health Insurance Service and included individuals aged 20-39 years who underwent health screening examinations between 2009 and 2012. The participants were categorized into either the non-SLD group or the SLD group, which was defined by a fatty liver index ≥ 30. SLD was further subclassified into MASLD, MetALD, and alcohol-associated liver disease (ALD) for analysis. The risk of incident AF was evaluated using Cox proportional hazards models.
A total of 6,375,710 young adults (mean age 30.9 years; 59.4% male) were included, with a median follow-up period of 10.6 years. The prevalence of SLD was 27.8%, which included cases of MASLD (81.7%), MetALD (13.5%), and ALD (4.7%). The risk of incident AF was significantly elevated in individuals with SLD, with progressive increases across MASLD, MetALD, and ALD subtypes. Compared with those of the non-SLD group, the adjusted hazard ratios for AF were 1.09 (95% confidence interval [CI], 1.05-1.31) in the MASLD group, 1.29 (95% CI, 1.22-1.36) in the MetALD group, and 1.52 (95% CI, 1.41-1.65) in the ALD group.
SLD is associated with new-onset AF, with a progressively increased risk across MASLD, MetALD, and ALD subtypes in young adults. Given the modifiable nature of these risks, early interventions are essential to prevent long-term cardiovascular complications and reduce the future disease burden.
背景/目的：代谢功能障碍正成为心房颤动（AF）的一个重要危险因素，并且是代谢功能障碍相关脂肪性肝病（MASLD）和中度饮酒的MASLD（代谢性酒精性肝病[MetALD]）的一个基本组成部分。随着脂肪性肝病（SLD）在年轻人中的患病率上升，阐明其与该人群AF的关联已成为临床优先事项。因此，我们旨在研究不同SLD亚型与年轻人发生AF风险之间的联系。
在这项全国性队列研究中，我们分析了韩国国民健康保险服务的数据，并纳入了2009年至2012年间接受健康筛查的20至39岁个体。参与者被分为非SLD组或SLD组，SLD组由脂肪肝指数≥30定义。SLD进一步细分为MASLD、MetALD和酒精性肝病（ALD）进行分析。使用Cox比例风险模型评估发生AF的风险。
共纳入6375710名年轻人（平均年龄30.9岁；59.4%为男性），中位随访期为10.6年。SLD的患病率为27.8%，其中包括MASLD（81.7%）、MetALD（13.5%）和ALD（4.7%）病例。SLD个体发生AF的风险显著升高，在MASLD、MetALD和ALD亚型中呈逐渐增加趋势。与非SLD组相比，MASLD组AF的调整后风险比为1.09（95%置信区间[CI]，1.05 - 1.31），MetALD组为1.29（95%CI，1.22 - 1.36），ALD组为1.52（95%CI，1.41 - 1.65）。
SLD与新发AF相关，在年轻人中，MASLD、MetALD和ALD亚型的风险逐渐增加。鉴于这些风险具有可改变的性质，早期干预对于预防长期心血管并发症和减轻未来疾病负担至关重要。
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