Abstract 16497: Non-Alcoholic Fatty Liver Disease and Atrial Fibrillation. Prevalence and Impact on Clinical Outcomes

Introduction:Non-alcoholic fatty liver disease (NAFLD) is the most common liver disease in the Western countries. The prevalence of NAFLD as well its impact on bleeding and thrombotic events in patients with atrial fibrillation (AF) is unknown.Hypothesis:To assess the prevalence of NAFLD in a large cohort of patients with AF and to correlate the presence of NAFLD to bleeding and ischemic complications.Methods:Prospective multicentre cohort study including 1735 patients with non-valvular AF on vitamin K antagonists (VKAs) or non-VKAs anticoagulants (NOACs). NAFLD was diagnosed by the validated Fatty Liver Index (FLI), with a cut-off ?60. Primary endpoints were the occurrence of major bleedings and cardiovascular events (CVEs).Results:NAFLD was diagnosed in 732 (42.2%) patients. Patients with NAFLD were younger, less frequently women, more likely to be treated with NOACs and to have obesity, dyslipidaemia and persistent/permanent AF. During a median follow-up of 18.7 months (3155 patient-years), we recorded 78 major bleedings (Incidence Rate [IR] 2.5%/year): 29 (2.1%/year) in patients with and 49 (2.7%/year) in patients without NAFLD (log-rank test p=0.227). Univariate Cox proportional regression analysis showed no association of NAFLD with major bleedings (HR 0.752, 95%CI 0.473-1.196, p=0.229). Similar findings were seen according to therapy with VKAs (HR 0.484, 95%CI 0.229-1.024, p=0.058) or NOACs (HR 1.027, 95%CI 0.546-1.935, p=0.933). One-hundred fifty-five CVEs occurred (IR 3.1%/year), 55 in patients with and 100 in patients without NAFLD (log-rank test p=0.122). No significant association was found between NAFLD and CVEs at multivariate Cox proportional regression analysis. In the entire population NOACs use was associated with lower CVEs compared to VKAs (HR, 0.611 95%CI 0.421-0.887, p=0.010).Conclusions:NAFLD is highly prevalent in AF but is not associated with higher bleeding or thrombotic risk.