Background and Aims: Atherosclerotic cardiovascular disease (ASCVD) remains a leading cause of mortality worldwide, with lipid abnormalities playing a central role in disease development. While the causal role of low-density lipoprotein cholesterol (LDL-C) in ASCVD is well-established, the long-term population impact of combined lipid profiles, particularly the HDL-C/LDL-C ratio, remains less clearly quantified. This study aimed to estimate the lifetime burden of cardiovascular outcomes associated with different lipid risk profiles using a patient-level simulation framework. Methods: The authors analyzed projected lifetime ASCVD events across four HDL-C/LDL-C risk strata, ranging from low (≥0.45) to very high (<0.25), using the National Health Model Database of Projected and Estimated Outcomes (NHM-DPEO)—a digital twin of national healthcare systems built from multiple data sources, including national health and demographic statistics and estimates from the relevant literature. The framework is structured as a patient-level simulation model that projects individual health trajectories over a lifetime horizon. Model outputs were assessed for plausibility by comparison with published epidemiological estimates. Results: The NHM simulation revealed a strong, graded relationship between lipid profiles and cardiovascular survival. Life expectancy declined from 80.2 years in the lowest risk group (HDL-C/LDL-C ≥ 0.45) to 63.0 years in the very-high-risk group (HDL-C/LDL-C < 0.25), a reduction of 17.2 years, with 13.7 fewer QALYs. Similarly, participants with LDL-C > 5.0 mmol/L had a life expectancy 13.4 years shorter than those with LDL-C < 3.1 mmol/L. The burden of ASCVD increased exponentially with worsening lipid ratios: MI events rose from 5000 to 73,090 per 100,000 births, with onset in the highest risk group occurring as early as age 20. Ischaemic heart disease followed a similar pattern, showing up to 92% of events attributable to elevated lipid risk. While ischaemic stroke risk displayed a more complex pattern due to earlier MI mortality in high-risk groups, overall cardiovascular mortality and lifetime event burden were dominated by LDL-driven disease. These findings demonstrate that sustained LDL-C reduction and balanced HDL-C/LDL-C ratios confer substantial survival benefits across both sexes and all age groups. Conclusions: This study shows that lipid balance has a decisive influence on cardiovascular survival. Sustained LDL-C reduction and favourable HDL-C/LDL-C ratios markedly extend life expectancy and delay the onset of MI and IHD. The magnitude of this survival benefit highlights the need for early and continuous lipid control as a cornerstone of ASCVD prevention. The NHM quantifies these lifetime effects, offering valuable insights for targeted strategies that improve both longevity and quality of life.

Introduction. Atrial fibrillation (AFib) is a health condition in which irregular heartbeats are registered in the chambers of the heart. The condition is characterized by the risk of developing blood clots which may lead to stroke. Objective. To evaluate the clinical and cost-effectiveness and safety of radiofrequency ablation (RFA) with implanted cardiac devices versus the Cox-Maze procedure (CM) in drug-resistant patients with AFib. Search strategy. PubMed, the Cochrane Library, NICE, and CADTH Evidence Driven have been used for the literature search. Search filters: systematic reviews, meta - analyzes, randomized controlled trials (RCTs); population: humans; date of publication: 5 -20 years. To assess the quality of systematic reviews and meta-analyses, we used the AMSTAR checklist. The ELSI checklist has been applied in order to check RFA for potential ethical, social and legal aspects. The article was peer-reviewed by two independent public health professionals. Results. The success rates of RFA varied and might be explained by AFib types and an electrophysiologist’s clinical experience. From the safety standpoint, the technology may cause rare complications (3-5%) as bleeding, thromboembolism, the pacemaker syndrome and some interactions with cardiac devices such as oversensing or transvenous lead dislodgment. From the societal implications, RFA improves patients’ recovery and allows them to be discharged from the clinic in 2-3 days so that it saves hospital resources, whereas CM requires the patients to stay in the hospital for 4 to 6 weeks. Conclusions. RFA with implanted cardiac devices is clinically effective and generally safe for the treatment of AFib in drug-resistant patients. Also, the health technology is potentially cost - effective and resource-saving for hospitals. Nonetheless, its clinical effects and economic implications in the long turn should be further investigated. Введение. Фибрилляция предсердий (ФП) – это физическое состояние, при котором в камерах сердца регистрируются нерегулярные сердечные сокращения. Данное состояние характеризуется риском развития тромбов, которые могут привести к инсульту. Цель. Оценить клиническую и экономическую эффективность, безопасность радиочастотной абляции (РЧА) с имплантацией сердечными устройствами по сравнению с процедурой Кокс – Мейз (КМ) у фармако-резистентных пациентов с ФП. Стратегия поиска. Для литературного поиска были использованы базы данных PubMed, the Cochrane Library, NICE, и CADTH Evidence Driven. Фильтры поиска: систематический обзор, мета-анализ, рандомизированные контроллируемые исследования (РКИ); популяция: люди; дата публикации: 5-20 лет. Для оценки качества систематических обзоров и мета-анализов, мы использовали чек-лист AMSTAR. Чек-лист ELSI был применен для проверки РЧА на предмет потенциальных этических, организационных, социальных и правовых аспектов технологии. Статья была рецензирована двумя независимыми специалистами общественного здравоохранения. Результаты. Показатели успешности РЧА варьировали и могут быть объяснены типами ФП и клиническим опытом электрофизиолога. С точки зрения безопасности, технология может вызывать редкие осложнения (3-5%), такие как кровотечение, тромбоэмболия, синдром кардиостимулятора и некоторые взаимодействия с сердечными устройствами, включая повышенную чувствительность или трансвенозное вытеснение свинца. С позиции социальных последствий, РЧА улучшает выздоровление пациентов и позволяет выписываться из клиники в течение 2-3 дней, что экономит ресурсы больницы, тогда как КМ требует, чтобы пациенты оставались в больнице от 4 до 6 недель. Выводы. РЧА с имплантированными сердечными устройствами - клинически эффективен и, в целом, безопасен для лечения фармако-резистентных пациентов с ФП. Кроме того, данная технология здравоохранения потенциально экономически эффективна и экономит ресурсы больниц. Тем не менее, ее клинические эффекты и экономические последствия в долгосрочной перспективе должны быть дополнительно изучены. Кіріспе. Жүрекше фибрилляциясы (ЖФ) – бұл жүрек камераларында тұрақты емес жүрек қысқартулары тіркелетін физикалық жағдай. Бұл жағдай инсультке әкелуі...