Standard Modifiable Cardiovascular Risk Factors and Prognostic Outcomes in Non-Valvular Atrial Fibrillation Patients on Oral Anticoagulants

Background Standard Modifiable Cardiovascular Risk Factors (SMurfs) influence Atrial fibrillation (AF). However, data on their cumulative prognostic effect in Asian non-valvular AF (NVAF) patients receiving oral anticoagulants (OACs) remain limited. This study investigated the association between the cumulative burden of SMurfs and the prognosis of these NVAF patients on oral anticoagulation (OAC) therapy. Methods This retrospective cohort study used Tianjin Health and Medical Data Platform (THMDP) data on 20 782 NVAF patients on OACs between 2015 and 2020. Patients were categorized into groups by the number of baseline SMurfs (0, 1-2, or 3-4: hypertension, diabetes, hyperlipidemia, smoking). Cox proportional hazards models assessed the association between SMurf burden group and the primary outcome (all-cause mortality) and secondary outcomes. Subgroup and sensitivity analyses were performed to evaluate the consistency and robustness of the findings. Results After adjusting for confounders, compared to the SMurf-less group, the hazard ratios (HRs) for all-cause mortality were 1.20 (95% confidence interval [CI]: 1.01-1.44) for the SMurf (1-2) group and 1.67 (95% CI: 1.33-2.08) for the SMurf (3-4) group. For ischemic stroke, the hazard ratio (HR) was 1.44 (95% CI: 1.03-1.99) for the SMurf (3-4) group, while the association was not significant for the SMurf (1-2) group. A more pronounced association between SMurfs and all-cause mortality was observed in patients with an estimated glomerular filtration rate (eGFR) < 60 mL/min/1.73 m 2 . Conclusion In Asian NVAF patients receiving OACs, a higher SMurf burden is significantly associated with an increased risk of all-cause mortality and ischemic stroke.