Atrial fibrillation and 13-year risk of CVD mortality in Russian population cohort

Funding Acknowledgements

Type of funding sources: Foundation. Main funding source(s): The study was supported by RFBR #20-313-90015, RAS # АААА-А17-117112850280-2

Introduction

Given the worldwide increase in life expectancy, ageing-related conditions are becoming increasingly important. Atrial fibrillation (AF) is the most common arrhythmia and a serious predictor of the progression of heart failure and thromboembolic events (largely, stroke). Thus, the study of AF impact on cardiovascular (CVD) mortality is of particular relevance.

Objectives

We aimed to analyze the impact of AF on the 13-year risk of CVD mortality in the Russian population sample of elderly age.

Methods

A random population sample (n=9360, age 45-69 years) was examined at baseline in 2003-2005 in the Russian arm of the HAPIEE project. The cohort was re-examined twice and was followed up for end points up to end of 2017 (12.7 years on the average). Fatal end-points were ascertained by local mortality register; the current study focused on CVD deaths. Baseline AF was defined by rest ECG with evaluation by the Minnesota code (MC 8-3-1, 8-3-2; 6-8 with "fibrillation" for atrium). Those with prevalent CVD at baseline and with inadequate ECGs were excluded from analysis; Cox-regression age- and multivariable-adjusted models were estimated.

Results

In total, data on 8565 persons aged 45-69 years at baseline were analyzed. Among those, 145 (1.6%) subjects had AF at baseline and of those 100 subjects had no existing CVD. During the 13-year follow-up, there were 431 cases of CVD death (10.9%) in the cohort, among them 63% (n=272) were fatal coronary heart disease (CHD) and 23% (n=101) were fatal stroke (2.5%). In age-adjusted models, men with baseline AF had increased risk of CVD death (HR=5.76; 95%CI 3.88-8.55), fatal stroke (HR=6.26; 95%CI 2.96-13.22), and fatal CHD (HR=5.86; 95%CI 3.58-9.59). After adjusting for other risk factors, the increased risk remained for all CVD outcomes: 4.49 (95%CI 2.84-7.09) for CVD death, 3.62 (95%CI 1.46-8.96) for fatal stroke, and 4.95 (95%CI 2.81-8.70) for fatal CHD. In women, the age-adjusted HR for CVD death in women with baseline AF was 3.92 (95%CI 1.60-9.62) but in fully-adjusted models the HR was attenuated (HR=2.22; 95%CI 0.87-5.70). The numbers of deaths from CHD and stroke in women were too small for meaningful analyses.

Conclusion

In this urban population-based cohort of subjects free from CVD at baseline, 11% of participants died from CVD death during 13 years follow-up. Men and women with baseline AF had approximately 4-fold increase in CVD mortality risk. The estimated CVD excess mortality risk associated with AF in this Russian cohort is consistent with findings from Western European and North American populations.

The frequency and profile of lipid lowering treatment in a contemporary Russian population

Background

Despite of guidelines for management of dyslipidemias (DLP) and the availability of effective and safe lipid lowering drugs (LLD), about one half of CVD patients do not reach the target lipid levels. The knowledge on DLP management in Russian population is limited.

Objective

To analyze the frequency and profile of LLD therapy in subjects with DLP and cardiometabolic diseases in a contemporary Russian population.

Methods

A random population sample of men and women 55–84 years old (n=3898) was examined in 2015–17 in the Russian arm of the HAPIEE project. A composite dysmetabolic group included DLP (total cholesterol, TC ≥5 mmo/l or low-density lipoprotein cholesterol, LDLC ≥3 mmol/l or triglycerides, TG ≥1.7 mmol/l) and/or coronary heart disease (CHD) and/or diabetes mellitus type 2 (DM2). Regular medication intake for 12 months was coded by ATC.

Results

In studied population sample 88% of subjects had dysmetabolic disorders (DLP - 83.1%, CHD - 14.9%, DM2- 20.8%); among them 32.8% subjects received LLD therapy (21.2% in men vs. 39.4% in women, p<0.001) and 17.1% did not report the status of LLD receiving. The frequency of LLD use in CHD group was 48,3%, in DM2 – 35,0%, in DLP – 29.4%. Among named LLD, statins were predominantly used (98%). Lipids control was achieved among subjects with CHD in 18.3% (37.9% among those receiving LLD); among DM2 - in 9.0% (25.6%); among DLP without CHD or DM2 – in 7.3% (24.8%).

Conclusion

In an urban population sample aged 55–84 examined in 2015–17, more than one half of subjects with dysmetabolic disorders (CHD, DM2, DLP) did not receive LLD. Among those receiving lipid-lowering therapy, the lipid control was achieved in about 40% of participants with CHD, and in every forth participant with DM2 or DLP. The lack of lipid control is likely to contribute high rate of atherosclerotic CVD in studied population.

Funding Acknowledgement

Type of funding sources: Foundation. Main funding source(s): Russian Foundation of Basic Research; Russian Academy of Sciences