Hepatic steatosis and incident cardiovascular events in patients with new-onset atrial fibrillation
S Sohn, D Lee, D Kang, H Kim, M Kim, J Choi, J Na, C Choi, E Kim, S Rha, C Park, Y Kim, S RohAbstract
Background
The relationship between hepatic steatosis (HS) and future cardiovascular risk in patients with atrial fibrillation (AF) is not well established. Additionally, the impact of changes in HS status on cardiovascular outcomes remains uncertain. We investigated the association between concurrent HS and major adverse cardiovascular events (MACE) in patients with new-onset AF and assessed how temporal changes in HS status influence MACE risk.
Methods
A nationwide population-based longitudinal cohort using data from the Korean National Health Insurance Service, including patients newly diagnosed with AF between 2013 and 2016, followed until the end of 2021, was analyzed from January to August 2024. Patients with new-onset AF were categorized based on their HS status at diagnosis, determined using the fatty liver index (FLI) with thresholds of 31 for men and 18 for women. Concurrent HS at the time of AF diagnosis and temporal changes in HS status following AF diagnosis were reviewed. The primary outcome was MACE, defined as a composite of heart failure (HF) hospitalization, ischemic stroke, and myocardial infarction (MI).
Results
Among 79,551 individuals newly diagnosed with AF (mean age 63.26±13.38 years; 52.4% male), 22,682 pairs were matched for HS status using propensity score matching (PSM). Over 382,971 person-years of follow-up, the HS group exhibited a 1.19-fold higher incidence of MACE compared to the non-HS group (72.2 vs.59.8 per 1,000 person-years; log-rank P<0.001). PSM-adjusted hazard ratios (HRs) for MACE, HF, and ischemic stroke increased by 9%, 12%, and 8%, respectively, in the HS group, with no significant difference in MI. Regression of HS status was associated with an 11% reduction in MACE risk, particularly in HF and ischemic stroke. A restricted cubic spline analysis revealed a non-linear, triphasic dose-response relationship between the FLI and MACE, with two distinct thresholds.
Conclusion
In this nationwide cohort study of patients with new-onset AF, concurrent HS was associated with an increased risk of future cardiovascular events. Notably, regression in HS status after AF diagnosis demonstrated significant cardiovascular benefits, particularly in reducing HF hospitalization and ischemic stroke.