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.

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Patients with combined coronary heart disease and diabetes mellitus make up a growing segment of the population and require a com¬prehensive treatment approach. Patients with concurrent diabetes mellitus and coronary heart disease have a worse projection. Under these conditions, the incidence of recurrent myocardial infarction, early disability due to complications, and the risk of coronary death are increased. Therefore, the priority task is to find ways to optimize drug treatment of this category of patients, taking into account the impact of drugs on the pathogenetic links of coronary heart disease progression and the development of cardiovascular complications. One hundred twelve people were examined in the research. The patients had type 2 diabetes with a history of non-Q-myocardial infarction receiving oral antidiabetic therapy and basic therapy, including an ACE inhibitor, a β-blocker, a statin, and an antiplatelet agent. Analysis of the investigated parameters in the leading group after receiving alpha-lipoic acid for 4 months showed a significant decrease in the concentration of C-Reactive Protein, IL-6 and TNF-α. According to the results of our research, taking alpha-lipoic acid for 4 months in patients with type 2 diabetes who underwent non-Q-myocardial infarction reduced the activity of systemic inflammation and did not significantly affect the content of anti-inflammatory IL-10 in patients. In light of the above, it is of interest to administer alpha-lipoic acid to these patients, considering the positive effects of the agent such as antioxidant properties, vasorelaxation, positive metabolic profile, as well as an anti-inflammatory potential.

The aim: To check changes of gut microbiota composition and its metabolites in atherosclerosis (AS) patients with or without atrial fibrillation (AF) and special connections between them and important clinic and laboratory features of investigated groups. Materials and methods: 300 patients were investigated. All investigated were divided into 3 groups: control group (CG) – 27 patients without AS and arrhythmias; mean group – 149 patients with AS but without arrhythmias; comparable group – 124 patients with AS and AF paroxysm. By 16-S rRNA sequencing was checked gut microbiota composition. The level of trimethylamine-N-oxide (TMAO), trimethylamine (TMA) plasma was determined by gas chromatography with mass electron detection. Results: The mean and comparable groups have the significant abundance of total bacterial mass, Bacteroides Spp., Faecalibacterium Prausnitzii, Actinobacter Spp. and decreas¬ing Ruminococcus Spp. In the comparable group to the mean significant increasing of Actinobacter Spp. and decreasing Eubacterium Rectale, Ruminococcus Spp. were checked. Bacteroides Fragilis Group/ Faecalibacterium Prausnitzii ratio was significantly higher than in patients’ comparable group. In the mean group patients compared with CG significant abundance of Streptococcus Spp. was checked. In the comparable group compared with CG significant leak of Eubacterium Rectale was checked. The highest amount of correlations was between Lactobacillus Spp., Streptococcus Spp. and clinic-laboratory changes. The mean and comparable groups the significant increasing of TMA ta TMAO plasma levels were checked. In patients of comparable group compared with patients mean group the significant increasing of TMAO plasma level was revealed. Conclusions: We checked special bacterial changes of gut microbiota that are common for patients with AS and AF comparable with AS patients. TMAO plasma levels are increased significantly for patients with AS and AF comparable with AS patients. Connections between AS and AF with TMAO plasma levels are confirmed by reliable correlations between TMAO and age, BMI, GFR, HDL levels. Special bacterial species are closely connected with age, BMI, GFR, HDL, LDL, plasma TMA and TMAO levels.

Statins are the integral medications for the management of patients with acute coronary syndrome including unstable angina (UA) with multiple pleiotropic effects. However, the influence of statins on the coagulation system is controversial. Our study aimed to explore the effects of atorvastatin and rosuvastatin in high doses on some coagulation parameters (prothrombin pool (PP) and soluble fibrin-monomer complexes (SFMC) concentration) after a 7-days follow-up period in patients with UA. We recruited 50 patients aged 55 to 70 years with progressive UA. Standard therapy according to ESC guidelines 2020 was recommended for all patients. Before treatment onset, they were divided into 2 groups: group A – 26 patients were prescribed atorvastatin, group R – 24 patients with rosuvastatin treatment. The blood samples to analyze the concentration of PP and SFMC were collected twice – before the treatment onset and 7 days after. We revealed significant decrease in PP concentration (p=0,02) and increase in SFMC concentration (p=0,01) in group A patients while there were no significant changes of investigated parameters (p=0,94, p=0,57 respectively) in group R. Additionally, we have noted significant negative correlation between baseline PP concentration and direction of PP changes (r=-0,803, p<0,001) as well as PP changes direction and SFMC concentration after treatment (r=-0,655, p<0,001). Thus, we may consider that atorvastatin and rosuvastatin are characterized by different influences on coagulation in patients with progressive UA with standard basic treatment. The rebound coagulation system activation after anticoagulant discontinuation is more pronounced in UA patients against a background of atorvastatin treatment in comparison with rosuvastatin.