Objective

To estimate the prevalence of nonalcoholic fatty liver disease (NAFLD) and its impact on bleeding and thrombotic events in patients with atrial fibrillation (AF).

Patients and Methods

Prospective multicenter cohort study including patients with nonvalvular AF receiving vitamin K antagonists (VKAs) or non-VKA oral anticoagulants (NOACs) from February 2008 for patients on VKA and from September 2013 for patients on NOACs. NAFLD was diagnosed using the validated fatty liver index, with a cutoff score of 60 or higher. Primary end points were the occurrence of major bleedings and cardiovascular events (CVEs).

Results

NAFLD was diagnosed in 732 of 1735 (42.2%) patients. Patients with NAFLD were younger, less frequently women, and more likely to be treated with NOACs and to have obesity, dyslipidemia, and persistent/permanent AF. During a median follow-up of 18.7 months (3155 patient-years), we recorded 78 major bleedings (incidence rate, 2.5% per year): 29 (2.1% per year) in patients with and 49 (2.7% per year) in patients without NAFLD (log-rank test P=.23). Univariate Cox proportional regression analysis showed no association of NAFLD with major bleedings (hazard ratio, 0.75; 95% CI, 0.47-1.20; P=.23). One hundred fifty-five CVEs occurred (incidence rate, 3.1% per year). No significant association was found between NAFLD and CVEs (log-rank test P=.12). In the entire population, NOAC use was associated with lower CVEs compared with VKAs (hazard ratio, 0.61; 95% CI, 0.42-0.89; P=.01).

Conclusion

NAFLD is highly prevalent in AF but is not associated with higher bleeding or thrombotic risk.

中文翻译：

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心房颤动中非酒精性脂肪肝的患病率及其影响。

客观的

评估非酒精性脂肪肝疾病（NAFLD）的发生率及其对房颤（AF）患者出血和血栓形成事件的影响。

患者和方法

从2008年2月开始对非瓣膜性房颤患者接受维生素K拮抗剂（VKA）或非VKA口服抗凝剂（NOAC）进行前瞻性多中心队列研究，从2013年9月开始对使用NOAC的患者进行研究。使用已验证的脂肪肝指数诊断NAFLD，其临界值在60或更高。主要终点是主要出血和心血管事件（CVE）的发生。

结果

1735名患者中有732名被诊断出NAFLD（42.2％）。NAFLD患者年龄较小，女性较少，并且更可能接受NOAC治疗，并且患有肥胖症，血脂异常和持续性/永久性AF。在18.7个月（3155个患者-年）的中位随访期间，我们记录了78例大出血（发生率，每年2.5％）：29例（每年2.1％）和49例（每年2.7％）。没有NAFLD的患者（对数秩检验P = .23）。单变量Cox比例回归分析显示NAFLD与严重出血无关联（危险比0.75； 95％CI为0.47-1.20；P = 0.23）。发生了155个CVE（发生率，每年3.1％）。在NAFLD和CVE之间未发现显着关联（对数秩检验P= .12）。在整个人群中，与VKA相比，NOAC的使用与较低的CVE相关（危险比，0.61； 95％CI，0.42-0.89；P = .01）。

结论

NAFLD在房颤中高度流行，但与更高的出血或血栓形成风险无关。