Cardiac ArrhythmiasCardiac ArrhythmiasCardiac ArrhythmiasCardiac Arrhythmias2782-42842782-4233Eco-Vector10557510.17816/cardar105575Original ResearchОригинальные исследованияResearch ArticleCorrection of Potentially Modifiable Components of Metabolic Syndrome for the Primary Prevention of Atrial Fibrillation in Comorbid Patients with Premature Atrial ComplexesРоль коррекции потенциально модифицируемых компонентов метаболического синдрома для первичной профилактики фибрилляции предсердий у коморбидных больных с преждевременными предсердными комплексамиhttps://orcid.org/0000-0001-7827-1052OlesinAleksandr I.ОлесинАлександр Иосифович
Russian Federation

Professor

профессор

olesin58@mail.ruhttps://orcid.org/0000-0003-3350-3088KonstantinovaIrina V.КонстантиноваИрина Викторовна
Russian Federation
i.konsta@yandex.ruhttps://orcid.org/0000-0001-5705-7057IvanovVladimir S.ИвановВладимир Сергеевич
Russian Federation
v.sivanov@yandex.ruI.I. Mechnikov North-West State Medical UniversityСеверо-Западный государственный медицинский университет им. И.И. Мечникова Минздрава РоссииSt. Elizabeth’s HospitalЕлизаветинская больница08092022250920222231402903202226082022Copyright ©; 2022, Olesin A.I., Konstantinova I.V., Ivanov V.S.Copyright ©; 2022, Олесин А.И., Константинова И.В., Иванов В.С.Copyright ©; 2022, Olesin A., Konstantinova I., Ivanov V.2022Olesin A.I., Konstantinova I.V., Ivanov V.S.Олесин А.И., Константинова И.В., Иванов В.С.Olesin A., Konstantinova I., Ivanov V.https://creativecommons.org/licenses/by-nc-nd/4.0https://journals.eco-vector.com/cardar/article/view/105575

AIM: The study aimed to evaluate the influence of the correction of potentially modifiable risk factors for the development of atrial fibrillation (AF) as primary prevention of AF in patients with metabolic syndrome (MS) and premature atrial complexes (PAC).

MATERIALS AND METHODS: We monitored 856 MS patients with PAC, aged 58–72 (mean age, 66.4 ± 0.7) years, in the north-western region of the Russian Federation. A 5-year risk of AF was calculated in all patients after the examination by determining the potential prognostic time range for Af development and its index of probable occurrence (RCHARGE-AF) using the CHARGE-AF model. The correction of potentially modifiable MS components and risk factors for AF development (smoking cessation, elimination of physical inactivity, etc.) until their target values were achieved was offered to all patients. The follow-up endpoint was the preservation of sinus rhythm or AF registration.

RESULTS: All patients with MS were distributed into three groups. Group I consisted of 557 (65.07%) patients with incomplete correction of risk factors, and group II included 93 (10.86%) who achieved the target values of all potentially modifiable factors for AF development. The control group included the remaining patients without quantitative and qualitative changes in the dynamics AF predictors. No significant differences were found between the groups in terms of sex, age, concomitant diseases, and risk factors for AF. The achievement of the target values of the main MS components, including body mass index and/or waist circumference, correlated with the performance of regular aerobic exercises (odds ratio [OR] = 8.9), adherence to a diet (OR = 7.5), duration of MS diagnosis < 20 years before the start of correction (OR = 12.8), and intake of a glucagon-like peptide-1 receptor agonist (Liraglutide) (OR = 5.4).

In the control group, group I, and group II, AF development did not differ significantly and was registered in 192 (93.20%), 491 (88.15%), and 79 (84.95%) patients (p > 0.05), respectively.

CONCLUSIONS: In MS patients with PAC and a high 5-year risk of AF, the correction of potentially modifiable risk factors for AF development, as its primary prevention, is ineffective. The determination of the RCHARGE-AF index in MS patients with PAC in dynamics indicates the efficiency of the correction of potentially modifiable risk factors for AF development, but it does not determine the degree of the risk of its occurrence.

The authors declare no conflict of interest.

Цель исследования ― оценить влияние коррекции потенциально модифицируемых факторов риска развития фибрилляции предсердий (ФП) в качестве первичной профилактики этой аритмии у пациентов метаболическим синдромом (МС) с внеочередными предсердными комплексами (ВПК).

Материал и методы. Наблюдалось 856 больных МС с ВПК Северо-Западного региона РФ в возрасте от 58 до 72 лет (в среднем 66,4 ± 0,7 года). У всех пациентов после обследования был рассчитан пятилетний риск развития ФП путем определения потенциально-прогностического временного диапазона ее развития и индекса вероятного возникновения этой аритмии (RCHARGE-AF), используя модель CHARGE-AF. Всем больным предлагалась коррекция потенциально модифицируемых компонентов МС и факторов риска развития ФП (отказ от табакокурения, устранение гиподинамии и т.д.) до достижения их целевых значений. Конечной точкой наблюдения считали сохранение синусового ритма или регистрация ФП.

Результаты. Все больные МС были распределены на три группы. I группу составили 557 (65,07 %) пациентов с неполной коррекцией, во II группу вошли 93 (10,86 %) ― с достигнутыми целевыми значениями всех потенциально модифицируемых факторов формирования ФП. Остальные пациенты без количественного и качественного изменения в динамике наблюдения предикторов развития этой аритмии были включены в контрольную группу. По полу, возрасту, сопутствующим заболеваниям, факторам риска развития ФП достоверного различия между группами выявлено не было. Достижение целевых значений основных компонентов МС, включая индекс массы тела и/или окружность талии, коррелировало с выполнением регулярных аэробных физических нагрузок [отношение шансов (ОШ) = 8,9], соблюдением диеты (ОШ = 7,5), продолжительностью регистрации МС менее 20 лет до начала коррекции (ОШ = 12,8), использованием агониста рецептора глюкагоноподобного пептида-1 (лираглутида) (ОШ = 5,4).

В контрольной, I и II группах развитие ФП достоверно не различалось и наблюдалось у 192 (93,20 %), 491 (88,15 %) и 79 (84,95 %) пациентов (p > 0,05) соответственно.

Заключение. У больных МС с ВПК и высоким пятилетним риском развития ФП коррекция потенциально модифицируемых факторов риска развития ФП, используемая в качестве ее первичной профилактики, неэффективна. Определение индекса RCHARGE-AF у больных МС с ВПК в динамике отражает эффективность коррекции потенциально модифицируемых факторов риска развития ФП, но он не определяет степень риска ее развития.

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