Nonalcoholic fatty liver disease is associated with increased risk of atrial fibrillation

Abstract Background & Aims Whether nonalcoholic fatty liver disease (NAFLD) is associated with risk of incident atrial fibrillation (AF) independent of established cardiovascular risk factors remains controversial. We aimed to provide a quantitative estimate of the association between NAFLD and risk of AF after adjustment for cardiometabolic risk factors. Methods In this study, we searched PubMed and Embase for studies published from database inception until January 31, 2020. Cohort studies reported adjusted relative risks (RRs) and 95% confidence intervals (CIs) for AF of NAFLD compared with non‐NAFLD were included for analysis. Results A total of 6 cohort studies were included, comprising 614 673 individuals for analysis. The median follow‐up duration was 10.0 years with 7271 cases of incident AF. Compared with non‐NAFLD, minimally adjusted models without adjustment for cardiometabolic risk factors showed that NAFLD was associated with increased risk of AF (RR 1.65, 95% CI 1.23‐2.20, I 2 = 63.0%). After adjustment for multiple cardiometabolic risk factors, the association between NAFLD and risk of AF was still higher than that in non‐NAFLD (RR 1.19, 95% CI 1.04‐1.31, I 2 = 54.0%). There was significant heterogeneity for the risk of AF between minimally and maximally adjusted models (I 2 = 77.1%, P for heterogeneity = 0.04). Compared with non‐NAFLD, the absolute risk increase in NAFLD for AF was 1.3 (95% CI 0.5‐2.1) per 1000 person‐years. Conclusions NAFLD is associated with increased risk of incident AF. The strength of the association between NAFLD and AF is partially attributed to the co‐existing cardiometabolic risk factors.