BackgroundAtrial fibrillation is associated with higher mortality. Identification of causes of death and contemporary risk factors for all‐cause mortality may guide interventions.Methods and ResultsIn the Rivaroxaban Once Daily Oral Direct Factor Xa Inhibition Compared with Vitamin K Antagonism for Prevention of Stroke and Embolism Trial in Atrial Fibrillation (ROCKET AF) study, patients with nonvalvular atrial fibrillation were randomized to rivaroxaban or dose‐adjusted warfarin. Cox proportional hazards regression with backward elimination identified factors at randomization that were independently associated with all‐cause mortality in the 14 171 participants in the intention‐to‐treat population. The median age was 73 years, and the mean CHADS 2 score was 3.5. Over 1.9 years of median follow‐up, 1214 (8.6%) patients died. Kaplan–Meier mortality rates were 4.2% at 1 year and 8.9% at 2 years. The majority of classified deaths (1081) were cardiovascular (72%), whereas only 6% were nonhemorrhagic stroke or systemic embolism. No significant difference in all‐cause mortality was observed between the rivaroxaban and warfarin arms (P=0.15). Heart failure (hazard ratio 1.51, 95% CI 1.33–1.70, P<0.0001) and age ≥75 years (hazard ratio 1.69, 95% CI 1.51–1.90, P<0.0001) were associated with higher all‐cause mortality. Multiple additional characteristics were independently associated with higher mortality, with decreasing creatinine clearance, chronic obstructive pulmonary disease, male sex, peripheral vascular disease, and diabetes being among the most strongly associated (model C‐index 0.677).ConclusionsIn a large population of patients anticoagulated for nonvalvular atrial fibrillation, ≈7 in 10 deaths were cardiovascular, whereas <1 in 10 deaths were caused by nonhemorrhagic stroke or systemic embolism. Optimal prevention and treatment of heart failure, renal impairment, chronic obstructive pulmonary disease, and diabetes may improve survival.Clinical Trial Registration URL: https://www.clinicaltrials.gov/. Unique identifier: NCT00403767.

Increase in life expectancy is among the most significant achievements of modern medicine. Currently, the majority of patients are elderly, being characterised by multimorbidity and frailty. Sarcopenia, a progressive and generalized loss of skeletal muscle mass and strength, is associated with a reduced quality of life and high risk of adverse outcomes including disability and death in these patients. Age-related neuromuscular degeneration, decline of circulating anabolic hormones, chronic inflammation and oxidative stress considerably affect the development of sarcopenia. In addition, low intake of proteins and carbohydrates along with a decrease in physical activity also affect muscular homeostasis. Being combined with obesity, osteopenia/osteoporosis, and vitamin D deficiency, sarcopenia worsens the prognosis of the patient in terms of life expectancy. In this review, we discuss the current advances in epidemiology, pathophysiology, and diagnosis of sarcopenia.

BackgroundThe impact of knee osteoarthritis on the risk of low-energy fractures remains an open question in recent times. Some cohort studies show that OА of the knee joint is associated with increased risk of fractures [1-3]. Other studies do not support this link [4-5].Objectivesto compare the incidence of osteopenic syndrome and low-energy fractures in postmenopausal women with osteoarthritis (OA) of the knee joint.MethodsThe study includes 98 women, of whom: 51 (median age 63.0 [59.3;69.8] years) are diagnosed with OA of the knee joint according to the ACR criteria (1991) and 47 without OA of the knee joint (median age 65.0[61.8;71.0] years). The bone mineral density (BMD) (g/cm2) and the T-criterion (standard deviation, CO) of the femur neck and lumbar spine (LI-LIV) were evaluated by the two-energy X-ray absorption (DXA) method (Lunar Prodigy Primo, USA). The DXA data of the femoral neck and the lumbar spine were interpreted using the following reference intervals: normal BMD - T-criterion -1 CO, osteopenia - T-criterion from -1 or less CO. Low-energy fractures were considered to have occurred with minimal trauma (falling from a height of own height to the same surface or an even smaller injury) and were found in the anamnesis.ResultsIn the group of patients with OA of the knee joint, normal BMD was found to be statistically significantly more frequent than the control group (15.7% vs. 4.3%) p=0.033. It is shown that in women with OA of the knee joint, low-energy fractures were statistically less recorded than in the control group: in 29.4% and 51.0% of women respectively (p=0.002). The chances of having low-energy fractures in the group of patients with OA of the knee joint were statistically lower by a factor of 2.64 compared to the control group (OR = 0.378; 95%CI: 0.203 - 0.703).ConclusionThe low frequency of low-energy fractures and the lower the chances of them in women with OA of the knee joint compared to the control group are probably associated with lower prevalence of the osteopenic syndrome among these patients.References[1]Smith TO, Higson E, Pearson M, Mansfield M. Is there an increased risk of falls and fractures in people with early diagnosed hip and knee osteoarthritis? Data from the Osteoarthritis Initiative. Int J Rheum Dis. 2018;21(6):1193-1201. doi:10.1111/1756-185X.12871[2]Soh SE, Barker AL, Morello RT, Ackerman IN. Applying the International Classification of Functioning, Disability and Health framework to determine the predictors of falls and fractures in people with osteoarthritis or at high risk of developing osteoarthritis: data from the Osteoarthritis Initiative. BMC Musculoskelet Disord. 2020;21(1):138. Published 2020 Feb 29. doi:10.1186/s12891-020-3160-5[3]Jacob L, Kostev K. Osteoarthritis and the incidence of fracture in the United Kingdom: a retrospective cohort study of 258,696 patients. Osteoarthritis Cartilage. 2021;29(2):215-221. doi:10.1016/j.joca.2020.12.006[4]Vala CH, Kärrholm J, Kanis JA, et al. Risk for hip fracture before and after total knee replacement in Sweden. Osteoporos Int. 2020;31(5):887-895. doi:10.1007/s00198-019-05241-x[5]Barbour KE, Sagawa N, Boudreau RM, et al. Knee Osteoarthritis and the Risk of Medically Treated Injurious Falls Among Older Adults: A Community-Based US Cohort Study. Arthritis Care Res (Hoboken). 2019;71(7):865-874. doi:10.1002/acr.23725AcknowledgementsWe thank Vyacheslav Fanaskov and Svetlana Skutina are radiologists of State Autonomous healthcare institution “Kuzbass clinical hospital for war veterans” for the possibility of holding the two-energy X-ray absorption.Disclosure of InterestsNone declared

О р и г и н а л ь н ы е и с с л е д о в а н и я 1 ФГБНУ Научно-исследовательский институт ревматологии им. В.А. Насоновой, Москва, Россия; 2 Кафедра пропедевтики внутренних болезней ГБОУ ВПО «Кемеровская государственная медицинская академия» Минздрава России, Кемерово, Россия; 3 Кафедра пропедевтики ГБОУ ВПО «Российский национальный исследовательский медицинский университет им. Н.И. Пирогова» Минздрава России,