Association between Metabolic Dysfunction-Associated Steatotic Liver Disease and Atrial Fibrillation: A Nationwide Cohort Study.

Background/Aims The recently proposed metabolic dysfunction-associated steatotic liver disease (MASLD) has been put forth as a more accurate representation of the metabolic aspects of fatty liver disease. The objective of this study was to examine the relationship between the various subtypes of SLD and the subsequent development of atrial fibrillation. Methods We identified participants who underwent health screenings in 2009 and 2010 using the KNHIS database and conducted a retrospective analysis of their data through 2019. The subjects were classified into six categories: no SLD without risk factor, no SLD with risk factor, MASLD without alcohol, MASLD with alcohol, MASLD with increased alcohol intake (MetALD), and alcohol-related liver disease (ALD). Hepatic steatosis was defined as fatty liver index ≥30. The primary outcome was the occurrence of newly diagnosed atrial fibrillation and ischemic stroke. Results There were 107,202 male (51.0%) and 102,751 female (49.0%). The adjusted hazard ratio (aHR) of the incidence of atrial fibrillation was derived as no SLD with risk factor 1.41 [95% CI: 1.24-1.60], MASLD with no alcohol 1.80 [95% CI: 1.57-2.06], MASLD with alcohol 1.93 [95% CI: 1.67-2.22], MetALD 2.21 [95% CI: 1.85-2.63], and ALD 1.88 [95% CI: 1.45-2.43] using No SLD without risk factor as a reference. The aHR of the incidence of Ischemic stroke was derived as no SLD with risk factor 1.59 [95% CI: 1.38-1.83], MASLD with no alcohol 2.04 [95% CI: 1.76-2.36], MASLD with alcohol 1.89 [95% CI: 1.62-2.21], MetALD 2.31 [95% CI: 1.91-2.79], and ALD 2.31 [95% CI: 1.78-2.98] using No SLD without risk factor as a reference. Conclusion We observed an increased prevalence of atrial fibrillation and ischemic stroke, a complication of atrial fibrillation, associated with the presence of cardiometabolic risk factors the presence of SLDs, and increased alcohol intake. [ABSTRACT FROM AUTHOR]