• Aditya Bhat, GanGary C HGCHDepartment of Cardiology, Blacktown Hospital, Sydney, New South Wales, Australia.School of Medicine, University of New South Wales, Sydney, New South Wales, Australia., Henry H L Chen, Sumreen Nawaz, Shaun Khanna, Timothy Dobbins, and Timothy C Tan.
• Department of Cardiology, Blacktown Hospital, Sydney, New South Wales, Australia.
• Eur. J. Clin. Invest. 2022 Sep 1; 52 (9): e13799.

BackgroundAtrial fibrillation (AF) is a prevalent disease with associated mortality risk, mediated in large part through its associated cardiovascular risk factors. Standard modifiable cardiovascular risk factors (SMuRFs; hypercholesterolaemia, hypertension, diabetes and smoking) are established drivers of cardiovascular disease; however, the importance of non-traditional mediators of cardiovascular risk (NTRFs) such as chronic renal impairment, obstructive sleep apnoea and obesity is emerging. The differential impact of these risk factors on outcomes in patients with AF is not well studied.MethodsConsecutive patients admitted to our service between January 2013 and January 2018 with a primary diagnosis of non-valvular AF were assessed. Assessment of demographic, anthropometric, risk factor profile and pharmacotherapeutics was performed. The clinical course of these patients was followed for up to five years for the composite outcome of all-cause death and major adverse cardiovascular events.ResultsOf the 1010 patients (62.29 ± 16.81 years, 51% men) included, 154 (15%) had no risk factors, 478 (47%) had only SMuRFs, 59 (6%) had only NTRFs and 319 (32%) had both SMuRFs and NTRFs. Over a mean follow-up period of 33.18 ± 21.27 months, a total of 288 patients met the composite outcome. On Cox regression, the coexistence of SMuRFs and NTRFs was an independent predictor of the composite outcome (HR 1.40; 95%CI 1.09-1.82, p = .01). Other independent predictors included age, heart failure, CHA2 DS2 VASc score, persistent AF and anaemia.ConclusionsThe presence of both SMuRFs and NTRFs has prognostic implications in patients with non-valvular AF.© 2022 Stichting European Society for Clinical Investigation Journal Foundation. Published by John Wiley & Sons Ltd.

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