Impact of clinical phenotypes on management and outcomes in European atrial fibrillation patients: a report from the ESC-EHRA EURObservational Research Programme in AF (EORP-AF) General Long-Term Registry

Background: Epidemiological studies in atrial fibrillation (AF) illustrate that clinical complexity increase the risk of major adverse outcomes. We aimed to describe European AF patients\u2019 clinical phenotypes and analyse the differential clinical course. Methods: We performed a hierarchical cluster analysis based on Ward\u2019s Method and Squared Euclidean Distance using 22 clinical binary variables, identifying the optimal number of clusters. We investigated differences in clinical management, use of healthcare resources and outcomes in a cohort of European AF patients from a Europe-wide observational registry. Results: A total of 9363 were available for this analysis. We identified three clusters: Cluster 1 (n = 3634; 38.8%) characterized by older patients and prevalent non-cardiac comorbidities; Cluster 2 (n = 2774; 29.6%) characterized by younger patients with low prevalence of comorbidities; Cluster 3 (n = 2955;31.6%) characterized by patients\u2019 prevalent cardiovascular risk factors/comorbidities. Over a mean follow-up of 22.5 months, Cluster 3 had the highest rate of cardiovascular events, all-cause death, and the composite outcome (combining the previous two) compared to Cluster 1 and Cluster 2 (all P <.001). An adjusted Cox regression showed that compared to Cluster 2, Cluster 3 (hazard ratio (HR) 2.87, 95% confidence interval (CI) 2.27\u20133.62; HR 3.42, 95%CI 2.72\u20134.31; HR 2.79, 95%CI 2.32\u20133.35), and Cluster 1 (HR 1.88, 95%CI 1.48\u20132.38; HR 2.50, 95%CI 1.98\u20133.15; HR 2.09, 95%CI 1.74\u20132.51) reported a higher risk for the three outcomes respectively. Conclusions: In European AF patients, three main clusters were identified, differentiated by differential presence of comorbidities. Both non-cardiac and cardiac comorbidities clusters were found to be associated with an increased risk of major adverse outcomes

Garlic Oil and Vitamin E Prevent the Adverse Effects of Lead Acetate and Ethanol Separately as well as in Combination in the Drinking Water of Rats

Daily feeding of drinking water containing lead acetate (160 mg/l) or 10% alcohol by volume or a combination of both to rats for a month produced certain deleterious effects through oxidative stress. Both heavy metal lead and alcohol are capable of doing such damages. The deleterious alterations observed were in the parameters of blood, serum and tissues, viz; Hb, Pb, proteins, lipids, lipid per oxidation, Vitamins C and E levels and enzyme activities of AST, ALT, and catalase. Simultaneous feeding of either of the two antioxidants garlic oil (GO) and vitamin E at equal doses of 100 mg/kg/day, to the rats counteracted the deleterious effects of the above two chemicals significantly. The maximum damage was brought about by feeding of drinking water containing both lead acetate and alcohol. The protective effects of GO and Vitamin E were not significantly different. The mechanism of actions of the Vitamin E and GO is probably due to their efficiency as detoxifying agents and antioxidants, to scavenging free radicals as well as an independent action of GO on the removal of lead salt as lead sulfide