ABSTRACT
AIMS: We aimed to assess the uptake of non-vitamin K antagonist oral anticoagulants (NOACs) among patients with atrial fibrillation between 2010 and 2015 in Switzerland. METHODS: We performed a prospective observational cohort study. At the baseline examination and during yearly follow-ups, we used questionnaires to obtain information about clinical characteristics and antithrombotic treatment. Stroke risk was assessed using the CHA2DS2-VASc score. RESULTS: 1545 patients were enrolled across seven centres in Switzerland. Mean age was 68 ± 12 years and 29.5% were female. The percentage of anticoagulated patients with an indication for oral anticoagulation (CHA2DS2-VASc score ≥2 in women and ≥1 in men) was 75% in 2010 and 80% in 2015 (p = 0.2). There was a gradual increase in the use of NOACs from 0% in 2010 to 29.8% in 2015 (p <0.0001). Out of 888 patients, who initially received a vitamin K antagonist (VKA), 86 (9.7%) were switched to an NOAC during follow-up. Use of aspirin as a monotherapy decreased from 23% in 2010 to 11% in 2015 (p <0.0001). CONCLUSION: After regulatory approval, the use of NOACs in Switzerland steadily increased to about 30% in 2015, whereas switches from VKAs to NOACs were infrequent. In parallel, the prescription of aspirin as monotherapy was more than halved, suggesting significant guideline-concordant improvements in oral anticoagulation use among patients with atrial fibrillation.
Subject(s)
Administration, Oral , Anticoagulants/therapeutic use , Atrial Fibrillation/drug therapy , Aged , Antithrombins/therapeutic use , Dabigatran/therapeutic use , Factor Xa Inhibitors/therapeutic use , Female , Humans , Male , Prospective Studies , Registries , Rivaroxaban/therapeutic use , Stroke/prevention & control , SwitzerlandABSTRACT
BACKGROUND: Lower birthweight is associated with an increased risk of cardiovascular diseases and diabetes. We hypothesized that inflammation and body fat may be potential mediators for these inverse relationships. MATERIALS AND METHODS: Healthy adults aged 25-41 years were enrolled in a prospective population-based cohort study in the Principality of Liechtenstein. Main exclusion criteria were diabetes, overt cardiovascular disease or a body mass index > 35 kg/m(2) . Birthweight was self-reported by the study participants. White blood cell (WBC) count and high-sensitivity C-reactive protein (hs-CRP) levels were assayed from fresh blood samples. Body composition was determined by bioelectrical impedance analysis. Multivariable linear regression models were constructed to assess the relationships between birthweight, inflammation and body composition. RESULTS: Our sample consisted of 1774 participants (53·4% females) with a median age of 37 years. Median birthweight was 3355 g. In multivariable models, we found an inverse relationship of birthweight with hs-CRP levels (ß -0·010 (95% CI -0·02; -0·002), P = 0·01) and WBC count (ß -0·002 (95% CI -0·004; -0·0002), P = 0·03). Additional adjustment for body fat mass attenuated these relationships (ß -0·008 (95% CI -0·02; 0·0003), P = 0·06 for hs-CRP levels and (ß -0·002 (95% CI -0·004; 0·0006), P = 0·16 for WBC count. Body fat mass itself was strongly associated with birthweight (ß -0·06 (95% CI -0·10; -0·03), P < 0·0001). CONCLUSION: Birthweight is inversely associated with inflammation in adulthood. This relationship may be mediated by an elevated body fat mass among individuals with lower birthweight.
