Publication: Lifestyle and cardiometabolic determinants of residual cardiovascular risk in anticoagulated patients with atrial fibrillation
Authors
Soler Espejo, Eva
item.page.secondaryauthor
Escuela Internacional de Doctorado
item.page.director
Roldán Schilling, Vanessa ; Marín Ortuño, Francisco
Publisher
Universidad de Murcia
publication.page.editor
publication.page.department
DOI
item.page.type
info:eu-repo/semantics/doctoralThesis
Description
Tesis por compendio de publicaciones
Abstract
Introducción: La fibrilación auricular (FA) es la arritmia sostenida más prevalente y constituye uno de los principales problemas de salud cardiovascular a nivel global. A pesar de que la anticoagulación oral (ACO) reduce de manera significativa la incidencia de ictus isquémico y embolias sistémicas, una proporción considerable de pacientes continúa experimentando eventos adversos. Esto pone de manifiesto las limitaciones de las herramientas tradicionales de estratificación del riesgo, como CHA2DS2-VASc, CHA2DS2-VA y HAS-BLED. Además, la FA se asocia frecuentemente con múltiples comorbilidades, lo que incrementa la heterogeneidad clínica y el riesgo de resultados cardiovasculares desfavorables. Esta tesis, presentada como un compendio de artículos originales, aborda el riesgo residual tromboembólico y cardiovascular en pacientes con FA tratados con ACO. Objetivos: Los objetivos de la tesis son los siguientes: (i) evaluar la adherencia a un estilo de vida saludable como predictor de eventos tromboembólicos y cardiovasculares, (ii) analizar el índice triglicérido-glucosa (TyG) como marcador de resistencia a la insulina y predictor de eventos cardiovasculares adversos, y (iii) estudiar el colesterol remanente (CR) y su discordancia con el colesterol unido a lipoproteínas de baja densidad (LDL-C) como indicador de riesgo tromboembólico y cardiovascular residual. Métodos: La investigación se desarrolló dentro de la cohorte Murcia Atrial Fibrillation Project III (MAFP-III), un registro prospectivo y observacional que incluyó pacientes con diagnóstico reciente de FA y candidatos a tratamiento anticoagulante oral. Los participantes fueron reclutados en dos hospitales de referencia de la Región de Murcia, con criterios de inclusión amplios para garantizar la representatividad de la muestra. La metodología abarcó tres áreas clave: (i) Estilo de vida saludable: se evaluaron factores como presión arterial, índice de masa corporal, glucosa, consumo de tabaco y alcohol. (ii) Índice TyG: calculado como Ln [triglicéridos en ayunas x glucosa en ayunas / 2], utilizado como marcador de resistencia a la insulina. (iii) Discordancia entre LDL-C y CR: el CR se estimó indirectamente con la fórmula colesterol total - colesterol HDL - LDL-C. El seguimiento fue prospectivo y se extendió por dos años, durante los cuales se documentaron eventos tromboembólicos y cardiovasculares, como ictus isquémico, accidente isquémico transitorio, embolismo sistémico, infarto agudo de miocardio y muerte cardiovascular, entre otros. Resultados: Los hallazgos clave fueron los siguientes: (i) Adherencia a un estilo de vida saludable: una alta adherencia a comportamientos saludables al momento del diagnóstico de FA se asoció independientemente con un menor riesgo de eventos tromboembólicos y cardiovasculares. No obstante, menos del 30% de los pacientes alcanzaron una alta adherencia, lo que subraya la necesidad de intervenciones preventivas secundarias; (ii) Índice TyG: valores elevados del índice TyG, indicador de resistencia a la insulina, se asociaron de manera independiente con un mayor riesgo cardiovascular en pacientes con FA tratados con ACO. Este índice se presenta como un biomarcador sencillo, económico y eficaz para una estratificación del riesgo más precisa; y (iii) Colesterol remanente y LDL-C: niveles elevados de CR estuvieron asociados con un mayor riesgo de eventos tromboembólicos, particularmente en pacientes con discordancia entre LDL-C bajo y CR elevado. Este resultado resalta las limitaciones del LDL-C como único marcador lipídico, destacando el papel complementario del CR en la evaluación del riesgo. Conclusiones: Los resultados de esta tesis proporcionan nuevas perspectivas sobre la estratificación de riesgo en pacientes con FA tratados con ACO. Incorporar variables como la adherencia a un estilo de vida saludable, el índice TyG y el CR en los marcos de evaluación de riesgo podría mejorar la identificación de pacientes de alto riesgo de eventos cardiovasculares. Esto permitiría optimizar las estrategias preventivas y apoyar una gestión más personalizada y eficaz de la FA.
Introduction: Atrial fibrillation (AF) is the most prevalent sustained arrhythmia and one of the leading cardiovascular health issues globally. Although oral anticoagulation (OAC) significantly reduces the incidence of ischaemic stroke and systemic embolism, a considerable proportion of patients continue to experience adverse events. This highlights the limitations of traditional risk stratification tools, such as CHA2DS2-VASc, CHA2DS2-VA, and HAS-BLED. Furthermore, AF is frequently associated with multiple comorbidities, which increases clinical heterogeneity and the risk of adverse cardiovascular outcomes. This thesis, presented as a compendium of original articles, investigates residual thromboembolic and cardiovascular risk in patients with AF treated with OAC. Objectives: The objectives of the thesis are as follows: (i) to evaluate adherence to a healthy lifestyle as a predictor of thromboembolic and cardiovascular events, (ii) to analyse the triglyceride-glucose (TyG) index as a marker of insulin resistance and predictor of adverse cardiovascular events, and (iii) to study remnant cholesterol (RC) and its discordance with low-density lipoprotein cholesterol (LDL-C) as an indicator of residual thromboembolic and cardiovascular risk .Methods: The research was conducted within the Murcia Atrial Fibrillation Project III (MAFP-III) cohort, a prospective and observational registry that included patients with a recent diagnosis of AF and candidates for oral anticoagulation therapy. Participants were recruited from two reference hospitals in the Region of Murcia, with broad inclusion criteria to ensure sample representativeness. The methodology encompassed three key areas: (i) Healthy lifestyle: factors such as blood pressure, body mass index, glucose, tobacco use, and alcohol consumption were assessed. (ii) TyG index: calculated as Ln [fasting triglycerides x fasting glucose / 2], used as a marker of insulin resistance. (iii) Discordance between LDL-C and RC: RC was estimated indirectly using the formula total cholesterol - HDL cholesterol - LDL-C. The follow-up was prospective, lasting two years, during which thromboembolic and cardiovascular events were documented, such as ischaemic stroke, transient ischaemic attack, systemic embolism, acute myocardial infarction, and cardiovascular death, among others. Results: The key findings were as follows: (i) Adherence to a healthy lifestyle: high adherence to healthy behaviours at the time of AF diagnosis was independently associated with a lower risk of thromboembolic and cardiovascular events. However, fewer than 30% of patients achieved high adherence, highlighting the need for secondary preventive interventions; (ii) TyG index: elevated TyG index values, reflecting insulin resistance, were independently associated with a higher cardiovascular risk in AF patients treated with OAC. This index emerges as a simple, cost-effective biomarker for more precise risk stratification; and (iii) Remnant cholesterol and LDL-C: elevated RC levels were independently associated with a higher risk of thromboembolic events, particularly in patients with discordance between low LDL-C and high RC. This finding underscores the limitations of LDL-C as a sole lipid marker and highlights the complementary role of RC in risk assessment. Conclusions: The findings of this thesis provide new insights into risk stratification in AF patients treated with OAC. Incorporating variables such as adherence to a healthy lifestyle, the TyG index, and RC into risk assessment frameworks could improve the identification of high-risk patients for cardiovascular events. This would allow for the optimisation of preventive strategies, supporting a more personalised and effective management of AF.
Introduction: Atrial fibrillation (AF) is the most prevalent sustained arrhythmia and one of the leading cardiovascular health issues globally. Although oral anticoagulation (OAC) significantly reduces the incidence of ischaemic stroke and systemic embolism, a considerable proportion of patients continue to experience adverse events. This highlights the limitations of traditional risk stratification tools, such as CHA2DS2-VASc, CHA2DS2-VA, and HAS-BLED. Furthermore, AF is frequently associated with multiple comorbidities, which increases clinical heterogeneity and the risk of adverse cardiovascular outcomes. This thesis, presented as a compendium of original articles, investigates residual thromboembolic and cardiovascular risk in patients with AF treated with OAC. Objectives: The objectives of the thesis are as follows: (i) to evaluate adherence to a healthy lifestyle as a predictor of thromboembolic and cardiovascular events, (ii) to analyse the triglyceride-glucose (TyG) index as a marker of insulin resistance and predictor of adverse cardiovascular events, and (iii) to study remnant cholesterol (RC) and its discordance with low-density lipoprotein cholesterol (LDL-C) as an indicator of residual thromboembolic and cardiovascular risk .Methods: The research was conducted within the Murcia Atrial Fibrillation Project III (MAFP-III) cohort, a prospective and observational registry that included patients with a recent diagnosis of AF and candidates for oral anticoagulation therapy. Participants were recruited from two reference hospitals in the Region of Murcia, with broad inclusion criteria to ensure sample representativeness. The methodology encompassed three key areas: (i) Healthy lifestyle: factors such as blood pressure, body mass index, glucose, tobacco use, and alcohol consumption were assessed. (ii) TyG index: calculated as Ln [fasting triglycerides x fasting glucose / 2], used as a marker of insulin resistance. (iii) Discordance between LDL-C and RC: RC was estimated indirectly using the formula total cholesterol - HDL cholesterol - LDL-C. The follow-up was prospective, lasting two years, during which thromboembolic and cardiovascular events were documented, such as ischaemic stroke, transient ischaemic attack, systemic embolism, acute myocardial infarction, and cardiovascular death, among others. Results: The key findings were as follows: (i) Adherence to a healthy lifestyle: high adherence to healthy behaviours at the time of AF diagnosis was independently associated with a lower risk of thromboembolic and cardiovascular events. However, fewer than 30% of patients achieved high adherence, highlighting the need for secondary preventive interventions; (ii) TyG index: elevated TyG index values, reflecting insulin resistance, were independently associated with a higher cardiovascular risk in AF patients treated with OAC. This index emerges as a simple, cost-effective biomarker for more precise risk stratification; and (iii) Remnant cholesterol and LDL-C: elevated RC levels were independently associated with a higher risk of thromboembolic events, particularly in patients with discordance between low LDL-C and high RC. This finding underscores the limitations of LDL-C as a sole lipid marker and highlights the complementary role of RC in risk assessment. Conclusions: The findings of this thesis provide new insights into risk stratification in AF patients treated with OAC. Incorporating variables such as adherence to a healthy lifestyle, the TyG index, and RC into risk assessment frameworks could improve the identification of high-risk patients for cardiovascular events. This would allow for the optimisation of preventive strategies, supporting a more personalised and effective management of AF.
publication.page.subject
Citation
item.page.embargo
Collections
Ir a Estadísticas
Este ítem está sujeto a una licencia Creative Commons. http://creativecommons.org/licenses/by-nc-nd/4.0/