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BackgroundAtrial fibrillation is associated with higher mortality. Identification of causes of death and contemporary risk factors for all‐cause mortality may guide interventions.Methods and ResultsIn 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<0.0001) and age ≥75 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).ConclusionsIn a large population of patients anticoagulated for nonvalvular atrial fibrillation, ≈7 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.Clinical Trial Registration
URL: https://www.clinicaltrials.gov/. Unique identifier: NCT00403767.
Objectives:to present currently available evidence to verify the association between
metabolic syndrome and quality of life. Method:Cochrane Library, EMBASE, Medline and LILACS databases were studied for all
studies investigating the association with metabolic syndrome and quality of life.
Two blinded reviewers extracted data and one more was chosen in case of doubt.
Results:a total of 30 studies were included, considering inclusion and exclusion criteria,
which involved 62.063 patients. Almost all studies suggested that metabolic
syndrome is significantly associated with impaired quality of life. Some, however,
found association only in women, or only if associated with depression or Body
Mass Index. Merely one study did not find association after adjusted for
confounding factors. Conclusion:although there are a few studies available about the relationship between
metabolic syndrome and quality of life, a growing body of evidence has shown
significant association between metabolic syndrome and the worsening of quality of
life. However, it is necessary to carry out further longitudinal studies to
confirm this association and verify whether this relationship is linear, or only
an association factor.
BackgroundLifestyle intervention programs can reduce the prevalence of metabolic
syndrome (MetS) and, therefore, reduce the risk for cardiac disease, one of
the main public health problems nowadays.ObjectiveThe aim of this study was to compare the effects of three types of approach
for lifestyle change programs in the reduction of metabolic parameters, and
to identify its impact on the quality of life (QOL) of individuals with
MetS.MethodsA randomized controlled trial included 72 individuals with MetS aged 30-59
years. Individuals were randomized into three groups of multidisciplinary
intervention [Standard Intervention (SI) - control group; Group Intervention
(GI); and Individual Intervention (II)] during 12 weeks. The primary outcome
was change in the metabolic parameters, and secondarily, the improvement in
QOL measures at three moments: baseline, 3 and 9 months.ResultsGroup and individual interventions resulted in a significant reduction in
body mass index, waist circumference, systolic blood pressure at 3 months
and the improvement of QOL, although it was significantly associated with
the physical functioning domain. However, these changes did not remain 6
months after the end of intervention. Depression and anxiety were
significantly associated with worse QOL, although they showed no effect on
the response to intervention.ConclusionMultidisciplinary intervention, especially in a group, might be an effective
and economically feasible strategy in the control of metabolic parameters of
MetS and improvement of QOL compared to SI, even in a dose-effect
relationship.
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