Impact of steatotic liver disease categories on atrial fibrillation in type 2 diabetes: a nationwide study

This study aims to investigate the incidence of new-onset atrial fibrillation (AF) in individuals with type 2 diabetes mellitus (T2DM) across different categories of steatotic liver disease (SLD). Using a health examination database between 2009 and 2012, this study included 2,480,880 patients. Participants were categorized into five groups based on hepatic steatosis (fatty liver index ≥ 60), cardiometabolic risk factors, and alcohol consumption. Cox regression analyses were performed. The metabolic dysfunction-associated steatotic liver disease (MASLD) group showed an increased risk of new-onset AF (adjusted hazard ratio (aHR), 1.10; 95% confidence interval (CI), 1.08-1.11). The MASLD with other combined group demonstrated increased AF development (aHR, 1.22; 95% CI, 1.18-1.26). In metabolic dysfunction and alcohol-related steatotic liver disease (MetALD) and alcohol-related liver disease (ALD) with metabolic groups, heavy to excessive alcohol consumption increased the risk of AF incidence, with the highest aHR associated with greater alcohol intake (aHR, 1.26; 95% CI, 1.22-1.29, 1.48; 95% CI, 1.41-1.55). MASLD increased the risk of AF in patients with T2DM, with a higher risk observed when accompanied by other liver diseases. Alcohol consumption was associated with proportional increase in the risk of AF, with excessive alcohol consumption associated with the highest risk of AF.