Association between non-alcoholic fatty liver disease and incidence of arrhythmia and other cardiovascular outcomes: a systematic review and meta-analysis

Abstract

Abstract Funding Acknowledgements Type of funding sources: None. Background The association between non-alcoholic fatty liver disease (NAFLD) with cardiovascular and cerebrovascular outcomes, as well as their clinical impact, has yet to be established in the literature. Objective We aim to evaluate the association between NAFLD patients and the risk of atrial fibrillation (AF), heart failure (HF),stroke, cardiovascular mortality (CVM), and peripheral revascularization. Method We performed a systematic literature search using the PubMed, Embase, Scopus, and Cochrane libraries for relevant articles from inception until July 20th, 2022. Odds ratios (OR) were pooled using a random-effect model, and a p-value of <0.05 was considered statistically significant. Results A total of 10 studies with 17886340 patients (2887214 NAFLD vs 14999126 non-NAFLD) were included in our analysis. The average age and percentage of males were comparable between groups, with a mean age of 55 years and 72.5% of males in the NAFLD group, whereas 52 years and 47.4% of males in the non-NAFLD group. The most common comorbidities among the NAFLD group included: hypertension (38% vs 24%), diabetes mellitus (14% vs 8%). The mean follow-up duration was 6.26 years. The likelihood of atrial fibrillation [OR, 1.42(95%CI: 1.18-1.70), P<0.001], heart failure [OR, 1.48(95%CI: 1.27-1.73), P<0.001], stroke (OR, 1.26(95%CI: 1.17-1.36), P<0.001], and peripheral revascularization (OR, 3.95(95%CI: 1.60-9.73), P=0.003] was significantly higher in NAFLD patients when compared with non-NAFLD patients. In contrast, cardiovascular mortality was comparable between both the groups of patients [OR, 3.11(95%CI: 0.32-30.03), P=0.33] respectively. Conclusion Patients with NAFLD demonstrated increased incidence of cardiovascular and/or cerebrovascular outcomes; heart failure, stroke, and arrhythmia. Patients with associated comorbidities were at higher risk of cardiovascular disease, implying a greater need for screening and adoption of cardio-protective measures amongst NAFLD patients.