Incident cardiac arrhythmias associated with metabolic dysfunction-associated steatotic liver disease: a nationwide histology cohort study

Table 2 Incident Overall Arrhythmias and Atrial Fibrillation among Adults with Histologically-Confirmed MASLD* and Matched Population Controls

	Population Controls (n = 51,856)	All MASLD (n = 11,206)	Simple Steatosis (n = 7642)	MASH without fibrosis (n = 1257)	Non-Cirrhotic Fibrosis (n = 1695)	Cirrhosis (n = 612)
Overall Arrhythmia
N. of events	6493	1351	946	135	187	83
Incidence rate per 1000 PY (95% CI)	8.66 [8.45–8.87]	10.31 [9.77–10.86]	9.74 [9.14–10.37]	9.99 [8.44–11.74]	11.99 [10.39–13.76]	17.19 [13.88–21.09]
Absolute rate difference, per 1000 PY (95% CI)	0 [ref.]	1.65 [1.06–2.24]	1.08 [0.42–1.73]	1.33 [-0.37–3.02]	3.33 [1.6–5.06]	8.54 [4.83–12.24]
• Minimally-adjusted Model 1 (95% CI)	1 [ref.]	1.44 [1.36–1.53]	1.39 [1.29–1.49]	1.48 [1.23–1.79]	1.48 [1.26–1.74]	2.05 [1.61–2.61]
• Multivariable-adjusted Model 2 (95% CI)	1 [ref.]	1.30 [1.22–1.38]	1.28 [1.19–1.38]	1.33 [1.09–1.61]	1.25 [1.05–1.48]	1.60 [1.21–2.12]
Atrial fibrillation
N. of events	5333	1055	735	105	154	61
Incidence rate per 1000 PY (95% CI)	7.05 [6.87–7.24]	7.96 [7.50–8.45]	7.48 [6.96–8.03]	7.71 [6.37–9.25]	9.80 [8.37–11.40]	12.37 [9.64–15.67]
Absolute rate difference, per 1000 PY (95% CI)	0 [ref.]	0.91 [0.39–1.42]	0.43 [-0.14–1]	0.66 [-0.83–2.14]	2.74 [1.18–4.3]	5.32 [2.21–8.43]
• Minimally-adjusted Model 1 (95% CI)	1 [ref.]	1.38 [1.30–1.48]	1.33 [1.23–1.44]	1.42 [1.15–1.76]	1.48 [1.24–1.76]	1.94 [1.47–2.57]
• Multivariable-adjusted Model 2 (95% CI)	1 [ref.]	1.26 [1.18–1.35]	1.24 [1.14–1.35]	1.34 [1.07–1.68]	1.24 [1.03–1.50]	1.59 [1.15–2.19]

MASLD metabolic dysfunction-associated steatotic liver disease; MASH metabolic dysfunction-associated steatohepatitis; N number; PY person years; HR hazard ratio; CI confidence interval; ref reference
^*MASLD was defined by liver histology. Overall arrhythmia was a composite endpoint that included atrial fibrillation, bradyarrhythmias, other supraventricular arrhythmias and ventricular arrhythmias/cardiac arrest. For definitions of MASLD and arrhythmia outcomes, please see the Methods and the eMethods
¹ Confidence intervals for incidence rates and absolute rate differences were approximated by the normal distribution. Incidence rate difference is per 1000 person years
² The minimally-adjusted model 1 accounted for matching factors (age at the index date, sex, calendar year and county of residence). The fully-adjusted multivariable model accounted for the minimal model plus education, the number of recorded hospital visits in the 1 year prior to the index date (or corresponding matching date), and covariates defined up to and including the index date (i.e. diabetes, obesity, hypertension, dyslipidemia, chronic kidney disease and family history of cardiovascular disease before age 50 years), and alcohol use disorder during follow-up (defined as a time-varying covariate). For definitions, see the eMethods and Additional file 1: Table S3

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