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
DOI:
https://doi.org/10.14739/2310-1237.2024.2.298891Keywords:
non-alcoholic fatty liver disease, atrial fibrillation, quercetin, ursodesoxycholic acid, myocardiumAbstract
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.
References
Le MH, Yeo YH, Li X, Li J, Zou B, Wu Y, et al. 2019 Global NAFLD Prevalence: A Systematic Review and Meta-analysis. Clin Gastroenterol Hepatol. 2022;20(12):2809-17.e28. doi: https://doi.org/https://doi.org/10.1016/j.cgh.2021.12.002
Riazi K, Azhari H, Charette JH, Underwood FE, King JA, Afshar EE, et al. The prevalence and incidence of NAFLD worldwide: a systematic review and meta-analysis. Lancet Gastroenterol Hepatol. 2022;7(9):851-61. doi: https://doi.org/https://doi.org/10.1016/S2468-1253(22)00165-0
Pafili K, Roden M. Nonalcoholic fatty liver disease (NAFLD) from pathogenesis to treatment concepts in humans. Mol Metab. 2021;50:101122. doi: https://doi.org/https://doi.org/10.1016/j.molmet.2020.101122
Kornej J, Börschel CS, Benjamin EJ, Schnabel RB. Epidemiology of Atrial Fibrillation in the 21st Century: Novel Methods and New Insights. Circ Res. 2020;127(1):4-20. doi: https://doi.org/https://doi.org/10.1161/CIRCRESAHA.120.316340
Heijman J, Linz D, Schotten U. Dynamics of Atrial Fibrillation Mechanisms and Comorbidities. Annu Rev Physiol. 2021;83:83-106. doi: https://doi.org/https://doi.org/10.1146/annurev-physiol-031720-085307
Nattel S, Heijman J, Zhou L, Dobrev D. Molecular Basis of Atrial Fibrillation Pathophysiology and Therapy: A Translational Perspective. Circ Res. 2020;127(1):51-72. doi: https://doi.org/https://doi.org/10.1161/CIRCRESAHA.120.316363
Mantovani A, Dalbeni A. Treatments for NAFLD: State of Art. Int J Mol Sci. 2021;22(5):2350. doi: https://doi.org/https://doi.org/10.3390/ijms22052350
Stan SI, Biciuşcă V, Clenciu D, Mitrea A, Boldeanu MV, Durand P, et al. The therapeutic mechanisms and beneficial effects of ursodeoxycholic acid in the treatment of nonalcoholic fatty liver disease: a systematic review. Med Pharm Rep. 2024;97(1):12-25. doi: https://doi.org/https://doi.org/10.15386/mpr-2629
Romiti GF, Pastori D, Rivera-Caravaca JM, Ding WY, Gue YX, Menichelli D, et al. Adherence to the 'Atrial Fibrillation Better Care' Pathway in Patients with Atrial Fibrillation: Impact on Clinical Outcomes-A Systematic Review and Meta-Analysis of 285,000 Patients. Thromb Haemost. 2022;122(3):406-14. doi: https://doi.org/https://doi.org/10.1055/a-1515-9630
Ministry of Health of Ukraine. [Unified clinical protocol of primary, secondary (specialized), tertiary (highly specialized) medical care for non-alcoholic steatohepatitis]. Order dated Nov 6 2014 No. 826 [Internet]. 2014 [cited 2024 Apr 4]. Ukrainian. Available from: https://www.dec.gov.ua/wp-content/uploads/2019/11/2014_826_ykpmd_nstpt.pdf
Hindricks G, Potpara T, Dagres N, Arbelo E, Bax JJ, Blomström-Lundqvist C, et al. 2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS): The Task Force for the diagnosis and management of atrial fibrillation of the European Society of Cardiology (ESC) Developed with the special contribution of the European Heart Rhythm Association (EHRA) of the ESC. Eur Heart J. 2021;42(5):373-498. doi: https://doi.org/https://doi.org/10.1093/eurheartj/ehaa612
Ministry of Health of Ukraine. [Unified clinical protocol of primary, secondary (specialized), tertiary (highly specialized) medical care for atrial fibrillation]. Order dated Jun 15 2016 No. 567 [Internet]. 2016 [cited 2024 Apr 4]. Ukrainian. Available from: https://www.dec.gov.ua/wp-content/uploads/2019/11/2016_597_ykpmd_fibrpreds.pdf
Wu P, Zhao J, Guo Y, Yu Y, Wu X, Xiao H. Ursodeoxycholic acid alleviates nonalcoholic fatty liver disease by inhibiting apoptosis and improving autophagy via activating AMPK. Biochem Biophys Res Commun. 2020;529(3):834-8. doi: https://doi.org/https://doi.org/10.1016/j.bbrc.2020.05.128
Azeem M, Hanif M, Mahmood K, Ameer N, Chughtai FRS, Abid U. An insight into anticancer, antioxidant, antimicrobial, antidiabetic and anti-inflammatory effects of quercetin: a review. Polym Bull (Berl). 2023;80(1):241-62. doi: https://doi.org/https://doi.org/10.1007/s00289-022-04091-8
John BV, Khakoo NS, Schwartz KB, Aitchenson G, Levy C, Dahman B, et al. Ursodeoxycholic Acid Response Is Associated With Reduced Mortality in Primary Biliary Cholangitis With Compensated Cirrhosis. Am J Gastroenterol. 2021;116(9):1913-23. doi: https://doi.org/https://doi.org/10.14309/ajg.0000000000001280
Cao P, Wang Y, Zhang C, Sullivan MA, Chen W, Jing X, et al. Quercetin ameliorates nonalcoholic fatty liver disease (NAFLD) via the promotion of AMPK-mediated hepatic mitophagy. J Nutr Biochem. 2023;120:109414. doi: https://doi.org/https://doi.org/10.1016/j.jnutbio.2023.109414
Wang L, Tan A, An X, Xia Y, Xie Y. Quercetin Dihydrate inhibition of cardiac fibrosis induced by angiotensin II in vivo and in vitro. Biomed Pharmacother. 2020;127:110205. doi: https://doi.org/https://doi.org/10.1016/j.biopha.2020.110205
Moonikh KO, Kashef M, Mahmoudi K, Salehpour M. Effects of quercetin supplementation on oxidative stress, blood pressure, aerobic power, concentric pathologic hypertrophy and cardiac function in men with hypertension and coronary artery disease after percutaneous coronary intervention: a randomized, double-blind placebo-controlled trial. Nutr Food Sci Res. 2020;7(2):21-8. doi: https://doi.org/https://doi.org/10.29252/nfsr.7.2.21
Sotiropoulou M, Katsaros I, Vailas M, Lidoriki I, Papatheodoridis GV, Kostomitsopoulos NG, et al. Nonalcoholic fatty liver disease: The role of quercetin and its therapeutic implications. Saudi J Gastroenterol. 2021;27(6):319-30. doi: https://doi.org/https://doi.org/10.4103/sjg.sjg_249_21
Raunsai MM, Elfahmi E, Chahyadi A, Suhandono S, Kristianti T, Al Muqarrabun LM. Ursodeoxycholic acid: a systematic review on the chemical and biochemical properties, biosynthesis, sources and pharmacological activities. Current Research in Biosciences and Biotechnology. 2021;3(1):178-85. doi: https://doi.org/https://doi.org/10.5614/crbb.2021.3.1/UJZVBNA0
Downloads
Additional Files
Published
How to Cite
Issue
Section
License
Authors who publish with this journal agree to the following terms:- Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
- Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
- Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work (SeeThe Effect of Open Access).