In this issue of the journal, Whitsett and colleagues have assessed the prevalence and impact of permanent (chronic) atrial fibrillation (AF) on healthcare utilization (defined as total hospitalizations and length of hospitalization) in a retrospective cohort of United States hospitalized patients with biopsy-proven nonalcoholic fatty liver disease (NAFLD).1 Over the past decade, it has become increasingly clear that NAFLD is just one facet of a multisystem disease that confers substantially increased morbidity and mortality on those patients who are affected and where the most common causes of mortality are cardiovascular disease (CVD) (~40–45% of the total deaths), followed by extra-hepatic malignancies and liver-related complications.2-4 Therefore, the increased CVD risk deserves particular attention, because it has important clinical implications for screening and surveillance strategies for the growing number of patients with NAFLD.2,3 In the past few years, it has also become increasingly clear that NAFLD adversely affects not only coronary arteries but also all other anatomical structures of the heart.5 Indeed, compelling evidence has emerged for a significant association between the presence and severity of NAFLD and risk of cardiomyopathy (mainly left ventricular dysfunction and hypertrophy, possibly leading to heart failure over time), cardiac valvular calcifications (mainly aortic-valve sclerosis and mitral annular calcification) and arrhythmias (mainly permanent AF and QTc interval prolongation).5 These findings further reinforce the notion that NAFLD is a multisystem disease that affects many extra-hepatic organ systems, including the heart and vasculature, by disrupting the regulation of multiple metabolic and proinflammatory pathways.5-7 This concept also implies that individuals with NAFLD should undergo careful cardiovascular surveillance, as recommended by the most recent European and American clinical practice guidelines for the management of NAFLD.8,9

Risk of atrial fibrillation in patients with nonalcoholic steatohepatitis

Targher, Giovanni
Writing – Original Draft Preparation
2019-01-01

Abstract

In this issue of the journal, Whitsett and colleagues have assessed the prevalence and impact of permanent (chronic) atrial fibrillation (AF) on healthcare utilization (defined as total hospitalizations and length of hospitalization) in a retrospective cohort of United States hospitalized patients with biopsy-proven nonalcoholic fatty liver disease (NAFLD).1 Over the past decade, it has become increasingly clear that NAFLD is just one facet of a multisystem disease that confers substantially increased morbidity and mortality on those patients who are affected and where the most common causes of mortality are cardiovascular disease (CVD) (~40–45% of the total deaths), followed by extra-hepatic malignancies and liver-related complications.2-4 Therefore, the increased CVD risk deserves particular attention, because it has important clinical implications for screening and surveillance strategies for the growing number of patients with NAFLD.2,3 In the past few years, it has also become increasingly clear that NAFLD adversely affects not only coronary arteries but also all other anatomical structures of the heart.5 Indeed, compelling evidence has emerged for a significant association between the presence and severity of NAFLD and risk of cardiomyopathy (mainly left ventricular dysfunction and hypertrophy, possibly leading to heart failure over time), cardiac valvular calcifications (mainly aortic-valve sclerosis and mitral annular calcification) and arrhythmias (mainly permanent AF and QTc interval prolongation).5 These findings further reinforce the notion that NAFLD is a multisystem disease that affects many extra-hepatic organ systems, including the heart and vasculature, by disrupting the regulation of multiple metabolic and proinflammatory pathways.5-7 This concept also implies that individuals with NAFLD should undergo careful cardiovascular surveillance, as recommended by the most recent European and American clinical practice guidelines for the management of NAFLD.8,9
2019
Atrial fibrillation, NASH, NAFLD
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11562/994589
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