What question did this study set out to answer?

To examine the impact of standard modifiable cardiovascular risk factors on the prognosis of Asian non-valvular atrial fibrillation patients receiving oral anticoagulants.

April 10, 2026Open Access

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

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Non-valvular atrial fibrillation (NVAF) (n=20782). Intervention: Standard Modifiable Cardiovascular Risk Factors (SMurfs) burden vs. 0 SMurfs (SMurf-less group). Primary outcome: all-cause mortality (HR 1.67, 95% CI 1.33-2.08).

Key Result

In Asian NVAF patients on oral anticoagulants, having 3-4 standard modifiable cardiovascular risk factors increased the risk of all-cause mortality compared to having none (HR 1.67; 95% CI 1.33-2.08).

Key Points

To examine the impact of standard modifiable cardiovascular risk factors on the prognosis of Asian non-valvular atrial fibrillation patients receiving oral anticoagulants.
Retrospective cohort design
Analyzed data from 20,782 NVAF patients on OACs from 2015 to 2020
Categorized patients by the number of baseline SMurfs (0, 1-2, or 3-4)
Used Cox proportional hazards models to assess outcomes
Conducted subgroup and sensitivity analyses to verify findings.
Significant increase in all-cause mortality for the SMurf (1-2) group (HR: 1.20) and SMurf (3-4) group (HR: 1.67) compared to SMurf-less group.
For the SMurf (3-4) group, increased risk of ischemic stroke (HR: 1.44) was noted; no significant risk for the SMurf (1-2) group.
Elevated associations with mortality were particularly strong in patients with eGFR < 60 mL/min/1.73 m².

Study Design

Type

Cohort (n=20,782)

Structured PICO

Does a higher burden of Standard Modifiable Cardiovascular Risk Factors (SMurfs) increase the risk of all-cause mortality and ischemic stroke in Asian patients with non-valvular atrial fibrillation on oral anticoagulants?

Population

20,782 Asian patients with non-valvular atrial fibrillation (NVAF) receiving oral anticoagulants (OACs)

Intervention

Presence of 1-2 or 3-4 Standard Modifiable Cardiovascular Risk Factors (SMurfs: hypertension, diabetes, hyperlipidemia, smoking)

Comparator

0 SMurfs (SMurf-less group)

Outcome

All-cause mortalityhard clinical

A higher burden of standard modifiable cardiovascular risk factors significantly increases the risk of all-cause mortality and ischemic stroke in Asian patients with non-valvular atrial fibrillation treated with oral anticoagulants.

Main Result

Effect estimate: HR 1.67 (95% CI 1.33-2.08)

Abstract

BackgroundStandard Modifiable Cardiovascular Risk Factors (SMurfs) influence Atrial fibrillation (AF). However, data on their cumulative prognostic effect in Asian non-valvular AF (NVAF) patients receiving oral anticoagulants (OACs) remain limited. This study investigated the association between the cumulative burden of SMurfs and the prognosis of these NVAF patients on oral anticoagulation (OAC) therapy.MethodsThis retrospective cohort study used Tianjin Health and Medical Data Platform (THMDP) data on 20 782 NVAF patients on OACs between 2015 and 2020. Patients were categorized into groups by the number of baseline SMurfs (0, 1-2, or 3-4: hypertension, diabetes, hyperlipidemia, smoking). Cox proportional hazards models assessed the association between SMurf burden group and the primary outcome (all-cause mortality) and secondary outcomes. Subgroup and sensitivity analyses were performed to evaluate the consistency and robustness of the findings.ResultsAfter adjusting for confounders, compared to the SMurf-less group, the hazard ratios (HRs) for all-cause mortality were 1.20 (95% confidence interval CI: 1.01-1.44) for the SMurf (1-2) group and 1.67 (95% CI: 1.33-2.08) for the SMurf (3-4) group. For ischemic stroke, the hazard ratio (HR) was 1.44 (95% CI: 1.03-1.99) for the SMurf (3-4) group, while the association was not significant for the SMurf (1-2) group. A more pronounced association between SMurfs and all-cause mortality was observed in patients with an estimated glomerular filtration rate (eGFR) 2.ConclusionIn Asian NVAF patients receiving OACs, a higher SMurf burden is significantly associated with an increased risk of all-cause mortality and ischemic stroke.