The combined effects of ursodesoxycholic acid and quercetin on liver health and cardiac function in patients with non-alcoholic fatty liver disease and atrial fibrillation

Non-alcoholic fatty liver disease (NAFLD) or due modern nomenclature – metabolic dysfunction-associated steatotic liver disease (MASLD) and atrial fibrillation are interconnected health problems that require reassessment of treatment strategies to address their common underlying causes. Lifestyle changes and pharmacotherapy are used to manage NAFLD, while treatment for atrial fibrillation focuses on anticoagulation and rhythm control. Aim. To evaluate the efficacy of combining ursodesoxycholic acid and quercetin with standard treatment to improve liver health and heart function in patients with non-alcoholic fatty liver disease and atrial fibrillation. Material and methods. A prospective, randomized controlled trial was conducted on patients with NAFLD and atrial fibrillation at two hospitals from January 2020 to December 2023. The study involved 127 patients who were divided into three groups: standard treatment, standard treatment + ursodesoxycholic acid (UDCA), and standard treatment + UDCA + quercetin. Results. The average age and sex distribution were similar among the three groups, suggesting that the randomization process successfully balanced the demographic characteristics. Paroxysmal atrial fibrillation was the most common form in all groups, followed by persistent atrial fibrillation and permanent atrial fibrillation, with no statistically significant differences between the groups. The body mass index was comparable across all three groups as well. The results showed a decrease in liver stiffness in all groups, with groups 2 and 3 showing the most significant improvements. Fibrosis stages also shifted after treatment, with group 3 showing a marked reduction in progressive fibrosis. Groups 2 and 3 also showed significant reductions in steatosis levels, with an increase in the proportion of patients without steatosis. Left atrial diameter decreased in all groups, with group 3 showing the most significant reduction. Left ventricular ejection fraction improved in all groups, with the most significant increase in group 3. Group 3 also showed improvements in diastolic filling and left ventricular filling pressure. Overall, the combined treatment regimen in group 3 appeared to have the most favourable effects on liver and cardiac health. Conclusions. The addition of UDCA and quercetin to standard treatment regimens for NAFLD and atrial fibrillation shows promising improvements in liver health and cardiac function.