: Publication 17086

Publication 17086

Title:	Fatty Liver Index Increases the Risk of Sudden Cardiac Arrest in Cardiovascular Disease-Free Adults
Journal:	Heart Rhythm
Published:	19 Dec 2025
Pubmed:	https://pubmed.ncbi.nlm.nih.gov/41422930/
DOI:	https://doi.org/10.1016/j.hrthm.2025.12.029

Abstract

BACKGROUND: The association between the newly defined metabolic dysfunction-associated steatotic liver disease (MASLD) and sudden cardiac arrest (SCA) remains unclear.

OBJECTIVE: This study aimed to investigate the association between MASLD, indicated by the fatty liver index (FLI), and SCA.

METHODS: This was a prospective cohort study of UK Biobank participants without baseline cardiovascular disease. MASLD was defined as an FLI of ≥30 plus ≥1 cardiometabolic risk factor. Multivariable Cox models and Fine-Gray competing risk analyses estimated hazard ratios (HRs) for incident SCA.

RESULTS: Among 347,925 participants, 1843 incident SCA events occurred over 14.1 years. SCA incidence increased significantly across FLI groups, from 2.15 per 10,000 person-years in the lowest group (FLI <30) to 7.17 per 10,000 person-years in the highest group (FLI ≥90) (P for trend < .001). Notably, for participants with an FLI of ≥30, SCA incidence increased exponentially with each additional cardiometabolic comorbidity. The fully adjusted Cox proportional hazards model showed an increase in SCA risk with higher FLI categories than group 1 (FLI <30), with group 2 (FLI 30-59) having an HR of 1.13 (95% confidence interval [CI] 0.99-1.30), group 3 (FLI 60-89) an HR of 1.21 (95% CI: 1.06-1.39), and group 4 (FLI ≥90) an HR of 1.57 (95% CI: 1.34-1.84). The association persisted in sensitivity analyses and after accounting for competing risks.

CONCLUSION: This large prospective study demonstrates that MASLD, indicated by higher FLI, is an independent risk factor for SCA. Findings underscore the importance of incorporating MASLD into cardiovascular risk assessment.

Abstract

15 Authors