Cause of Death and Predictors of All-Cause Mortality in Anticoagulated Patients With Nonvalvular Atrial Fibrillation : Data From ROCKET AF

M. Kaste on työryhmän ROCKET AF Steering Comm jäsen.Background-Atrial fibrillation is associated with higher mortality. Identification of causes of death and contemporary risk factors for all-cause mortality may guide interventions. Methods and Results-In the Rivaroxaban Once Daily Oral Direct Factor Xa Inhibition Compared with Vitamin K Antagonism for Prevention of Stroke and Embolism Trial in Atrial Fibrillation (ROCKET AF) study, patients with nonvalvular atrial fibrillation were randomized to rivaroxaban or dose-adjusted warfarin. Cox proportional hazards regression with backward elimination identified factors at randomization that were independently associated with all-cause mortality in the 14 171 participants in the intention-to-treat population. The median age was 73 years, and the mean CHADS(2) score was 3.5. Over 1.9 years of median follow-up, 1214 (8.6%) patients died. Kaplan-Meier mortality rates were 4.2% at 1 year and 8.9% at 2 years. The majority of classified deaths (1081) were cardiovascular (72%), whereas only 6% were nonhemorrhagic stroke or systemic embolism. No significant difference in all-cause mortality was observed between the rivaroxaban and warfarin arms (P=0.15). Heart failure (hazard ratio 1.51, 95% CI 1.33-1.70, P= 75 years (hazard ratio 1.69, 95% CI 1.51-1.90, P Conclusions-In a large population of patients anticoagulated for nonvalvular atrial fibrillation, approximate to 7 in 10 deaths were cardiovascular, whereasPeer reviewe

Gender and age-specific structural and geometric myocardial remodeling in arterial hypertension

Heart remodeling, heart rate variability, QT dispersion, and myocardial ectopic activity were studied in arterial hypertension (AH) patients, according to their gender and age. In total, 387 individuals with AH were examined: 189 males, and 198 females. The control group included 195 relatively healthy persons (99 males, 96 females). All participants underwent echocardiography, and Hotter ECG monitoring. Hypertensive males demonstrated sympathic hypertonus, cQT dispersion, and higher rate of potentially dangerous ventricular arrhythmias, that was associated with increased risk of sudden arrhythmic death, and concentric left ventricular hypertrophy (LVH). In females aged 50-59, eccentric IVHwas more prevalent. Greater structural and functional disturbances in males could be explained by more frequent (85 %) combination of AH and coronary heart disease (CHD); 92 % > of females had isolated AH

SNIZhENIE MINERAL'NOY PLOTNOSTI KOSTNOY TKANI -DOPOLNITEL'NYY KRITERIY STRATIFIKATsII SERDEChNOSOSUDISTOGO RISKA U ZhENShchIN POSTMENOPAUZAL'NOGO PERIODA S ARTERIAL'NOY GIPERTONIEY

Изучены особенности сердечно-сосудистого ремоделирования у нормотензивных пациенток и женщин с АГ и пост- менопаузальным остеопеническим синдромом (ОП). Обследовано 207 женщин постменопаузального периода: 62 - с АГ и ОП; 43 - с АГ и нормальной МПКТ; 52 - нормотензивные пациентки с ОП, 50 - нормотензивных женщин с нормаль- ной МПКТ. Установлена взаимосвязь МПК с параметрами сердечно-сосудистого ремоделирования. Показано, что сни- жение МПК является маркером неблагоприятных концентрических вариантов ремоделирования сердца, нарушения диастолического наполнения желудочков по гипертрофическому типу и увеличения комплекса интима-медиа сонных артерий

PLEIOTROPIC EFFECTS OF THE BONE METABOLISM MODULATOR - STRONTIUM RANELATE IN TREATMENT OF WOMEN WITH THE POSTMENOPAUSAL OSTEOPOROSIS AND ARTERIAL HYPERTENSION.

The trial was aimed at studying the effects of the modulator of bone metabolism - strontium ranelate on the parameters of cardiovascular remodeling in women with postmenopausal osteoporosis (OP) and arterial hypertension (AH). This effect includes the results of study of strontium ranelate in 48 women with postmenopausal osteoporosis AH 1-2 degrees and moderate or high cardiovascular risk. During 36 weeks 25 patients, in addition to antihypertensive therapy and calcium supplementation received strontium ranelate (Bivalos) 2 g / day. Bone mineral density (BMD) was evaluated by dual energy X-ray absorptiometry. The effect of strontium ranelate treatment on the thickness of the intima-media of the carotid artery (IMT) by the method of duplex scanning on structural and functional parameters of the heart by echocardiography also evaluated. Adding of strontium ranelate to the antihypertensive treatment and calcium supplementation in women with postmenopausal OP and AH has a positive effect on central hemodynamics, cardiovascular remodeling and diastolic filling

Cause of death and predictors of all-cause mortality in anticoagulated patients with nonvalvular atrial fibrillation: Data from ROCKET AF

Background-Atrial fibrillation is associated with higher mortality. Identification of causes of death and contemporary risk factors for all-cause mortality may guide interventions. Methods and Results-In the Rivaroxaban Once Daily Oral Direct Factor Xa Inhibition Compared with Vitamin K Antagonism for Prevention of Stroke and Embolism Trial in Atrial Fibrillation (ROCKET AF) study, patients with nonvalvular atrial fibrillation were randomized to rivaroxaban or dose-adjusted warfarin. Cox proportional hazards regression with backward elimination identified factors at randomization that were independently associated with all-cause mortality in the 14 171 participants in the intentionto- treat population. The median age was 73 years, and the mean CHADS2 score was 3.5. Over 1.9 years of median follow-up, 1214 (8.6%) patients died. Kaplan-Meier mortality rates were 4.2% at 1 year and 8.9% at 2 years. The majority of classified deaths (1081) were cardiovascular (72%), whereas only 6% were nonhemorrhagic stroke or systemic embolism. No significant difference in all-cause mortality was observed between the rivaroxaban and warfarin arms (P=0.15). Heart failure (hazard ratio 1.51, 95% CI 1.33-1.70, P<0.0001) and age 6575 years (hazard ratio 1.69, 95% CI 1.51-1.90, P<0.0001) were associated with higher all-cause mortality. Multiple additional characteristics were independently associated with higher mortality, with decreasing creatinine clearance, chronic obstructive pulmonary disease, male sex, peripheral vascular disease, and diabetes being among the most strongly associated (model C-index 0.677). Conclusions-In a large population of patients anticoagulated for nonvalvular atrial fibrillation, 487 in 10 deaths were cardiovascular, whereas <1 in 10 deaths were caused by nonhemorrhagic stroke or systemic embolism. Optimal prevention and treatment of heart failure, renal impairment, chronic obstructive pulmonary disease, and diabetes may improve survival