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Standard Modifiable Cardiovascular Risk Factors and Prognostic Outcomes in Non-Valvular Atrial Fibrillation Patients

Linhao Liu1, Hangkuan Liu1, Pengfei Sun1

  • 1Department of Cardiology, Tianjin Medical University General Hospital, Tianjin Medical University, Tianjin, China.

Clinical and Applied Thrombosis/Hemostasis : Official Journal of the International Academy of Clinical and Applied Thrombosis/Hemostasis
|April 7, 2026
PubMed

Insights

Higher burden of Standard Modifiable Cardiovascular Risk Factors (SMurfs) increases mortality risk in Asian patients with non-valvular atrial fibrillation (NVAF) on oral anticoagulants. Managing these risk factors is crucial for improving prognosis in NVAF patients.

Area of Science:

  • Cardiology
  • Public Health
  • Epidemiology

Background:

  • Standard Modifiable Cardiovascular Risk Factors (SMurfs) are known to influence atrial fibrillation (AF).
  • Limited data exist on the cumulative prognostic impact of SMurfs in Asian non-valvular AF (NVAF) patients on oral anticoagulants (OACs).
  • This study addresses the gap by investigating the association between cumulative SMurf burden and outcomes in this specific patient population.

Purpose of the Study:

  • To investigate the association between the cumulative burden of SMurfs and the prognosis of Asian NVAF patients receiving OAC therapy.
  • To assess the impact of SMurf burden on all-cause mortality and ischemic stroke risk in this cohort.

Main Methods:

  • Retrospective cohort study utilizing data from the Tianjin Health and Medical Data Platform (THMDP) from 2015-2020.
  • Included 20,782 NVAF patients on OACs, categorized by baseline SMurf count (0, 1-2, or 3-4: hypertension, diabetes, hyperlipidemia, smoking).
  • Cox proportional hazards models were used to analyze outcomes, with subgroup and sensitivity analyses performed for robustness.

Main Results:

  • A higher SMurf burden was significantly associated with increased all-cause mortality.
  • Compared to the SMurf-less group, HRs for all-cause mortality were 1.20 (SMurfs 1-2) and 1.67 (SMurfs 3-4).
  • The SMurf (3-4) group showed a significant increased risk for ischemic stroke (HR 1.44), with no significant association for the SMurf (1-2) group. A more pronounced association between SMurfs and mortality was observed in patients with eGFR < 60 mL/min/1.73 m².

Conclusions:

  • In Asian NVAF patients on OACs, a greater cumulative burden of SMurfs is linked to a significantly higher risk of all-cause mortality and ischemic stroke.
  • These findings underscore the importance of managing cardiovascular risk factors in NVAF patients receiving OACs to improve clinical outcomes.
  • The study highlights a pronounced association in patients with reduced kidney function (eGFR < 60).

Keywords:
atrial fibrillationprognosisrisk factor

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