Standard modifiable cardiovascular risk factors and prognostic outcomes in non-valvular atrial fibrillation on oral anticoagulants

Atrial fibrillation (AF) is the most common arrhythmia globally, and AF patients often have comorbidities and modifiable risk factors, such as hypertension, diabetes, hyperlipidemia, and smoking, which increase their risk of complications and mortality. Managing these modifiable risk factors is essential for AF management. Furthermore, with the increasing use of anticoagulation therapy, understanding the relationship between modifiable risk factors and prognosis in AF patients on oral anticoagulants (OAC) is crucial.

This study aims to investigate the impact of standard modifiable cardiovascular risk factors (SMurf) on the prognosis of non-valvular AF patients receiving OAC therapy.

This retrospective cohort study utilized data from the Tianjin Health and Medical Data Platform in China. A total of 20,782 non-valvular AF patients who received OAC therapy between 2015 and 2020 were identified for analysis. Patients were categorized based on baseline SMurf number: SMurf (0), SMurf (1-2), and SMurf (3-4). Cox proportional hazards models were used to analyze the relationship between SMurf and outcomes. Subgroup and sensitivity analyses were conducted to validate the results.

Compared to SMurf (0), the risk of all-cause mortality were significantly higher in SMurf (1-2) and SMurf (3-4) [SMurf (1-2): Hazard Ratio (HR) = 1.20, 95% Confidence Interval (CI): 1.01-1.44, P = 0.041; SMurf (3-4): HR = 1.67, 95% CI: 1.34-2.09, P < 0.001]. The risk of composite ischemic outcome and ischemic stroke was significantly higher in the SMurf (3-4) [composite ischemic outcomes: HR = 1.47, 95%CI: 1.11-1.94, P = 0.007; ischemic stroke: HR = 1.44, 95%CI: 1.04-1.99, P = 0.030], but not in the SMurf (1-2). The association between SMurf and all-cause mortality was consistent across subgroups, with a stronger correlation observed in patients with eGFR < 60 mL/min/1.73m2 (P for interaction < 0.001). Competing risk analysis revealed that SMurf significantly increased the risk of death from circulatory diseases. Sensitivity analysis confirmed the robustness of these findings.

In Asian patients with non-valvular AF on OAC therapy, a greater number of SMurf was associated with an increased risk of all-cause mortality and ischemic stroke.

Graphical Abstract