Daniele Pastori1, Angela Sciacqua2, Rossella Marcucci3, Alessio Farcomeni4, Francesco Perticone2, Maria Del Ben1, Francesco Angelico4, Francesco Baratta1, Pasquale Pignatelli5, Francesco Violi6. 1. I Clinica Medica, Atherothrombosis Centre, Department of Internal Medicine and Medical Specialties of Sapienza University of Rome, Italy. 2. Department of Medical and Surgical Sciences, University Magna Græcia of Catanzaro, Italy. 3. Department of Experimental and Clinical Medicine, University of Florence, Italy. 4. Department of Public Health and Infectious Diseases, Sapienza University of Rome, Italy. 5. I Clinica Medica, Atherothrombosis Centre, Department of Internal Medicine and Medical Specialties of Sapienza University of Rome, Italy; Mediterranea Cardiocentro, Naples, Italy. 6. I Clinica Medica, Atherothrombosis Centre, Department of Internal Medicine and Medical Specialties of Sapienza University of Rome, Italy; Mediterranea Cardiocentro, Naples, Italy. Electronic address: francesco.violi@uniroma1.it.
Abstract
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.
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.
Authors: Stefan Chiriac; Carol Stanciu; Irina Girleanu; Camelia Cojocariu; Catalin Sfarti; Ana-Maria Singeap; Tudor Cuciureanu; Laura Huiban; Cristina Maria Muzica; Sebastian Zenovia; Robert Nastasa; Anca Trifan Journal: Can J Gastroenterol Hepatol Date: 2021-01-12
Authors: Daniele Pastori; Angela Sciacqua; Rossella Marcucci; Maria Del Ben; Francesco Baratta; Francesco Violi; Pasquale Pignatelli Journal: Intern Emerg Med Date: 2021-03-13 Impact factor: 3.397