Characteristics Of Lipid Metabolism In Aged Patients With Coronary Heart Disease

Objective:The study aims to explore the characteristics of lipid metabolism of aged patients with coronary heart disease(CHD), especially, to assess the clinical forecast value of lipid ratio in the process of CHD’s outbreak and development. Due to the fact dyslipidemia will speed up the process of atherosclerosis, the study will further explore the influence of dyslipidemia on renal functions and blood coagulation system. Because more than one organ disease often happen on the aged patients, the study will pay special attention to the effect of renal and liver functions on CHD and meanwhile explore the clinical significance of creatinine clearance (Ccr) and total bilirubin (TBIL) levels for aged patients with coronary heart disease(CHD). As we all know, BNP is a sensitive index of evaluating heart function, the study will adopt the method of subgroup analysis, to explore the inner links between BNP and lipids, BNP and Fib. The final purpose of the study is to, through a serials of research mentioned above, discover the onset characteristics of aged coronary heart disease, the inner links between some risk factors and the final outcome they may bring about.Methods:According to coronary artery angiography (CAG),784 subjects aged more than 65 years were divided into several groups. There are 116 subjects in control group,106 subjects in one-vessel group,120 subjects in two-vessel group,442 subjects in three-vessel group. Among them,500 subjects underwent coronary artery bypass graft,168 subjects underwent percutaneous coronary intervention. The above subjects will be divided into different groups according to the number of coronary artery stenosis vessel, sex, whether they have experienced hypertension or diabetes mellitus and etc. The study will further compare the above indexes, analyze their inner links and their influence on the outbreak of aged coronary heart disease.Results:1.With the increased number of involved branches, apolipoprotein B(Apo B) level, total cholesterol(TC)/high-density lipoprotein (HDL), low-density lipoprotein (LDL)/HDL ratio were gradually increased, the levels of HDL-C and apolipoprotein Al(ApoAl)/B were gradually decreased(P<0.05), whether male or female.2.The levels of triglyceride(TG) and Apo B increased, ApoAl/B decreased in hypertension group(P<0.05).3.The levels of TG and TC/HDL increased, HDL decreased in diabetes mellitus group(P<0.05).4. Multi-Logistic regression analysis showed that ApoAl/B was an independent risk factor of CHD.5. The levels of apolipoprotein A1 (ApoAl) decreased and apolipoprotein B (Apo B) increased in the Moderate-Severe injury of renal functional group (CCr<50 ml/min) (P<0.01).6. The level of Ccr related to the levels of ApoAl and Apo B in the male group (P<0.05 or P<0.01). The level of Ccr related to the levels of ApoAl,Apo B and HDL-C in the CHD group(P<0.05或P<0.01).7. Multi-Logistic regression analysis showed that Ccr, HDL-C. ApoAl and Apo B were influencing factors of CHD.8. With the increased number of involved branches, the level of Lp(a) was gradually increased in male group (P<0.01).9.Whether male or female. with the increased number of involved branches, the levels of Fib were gradually increased(P<0.05 or P<0.01). 10. The level of Lp(a) had positive correlation with Fib in male group (P<0.01).11. The level of Ccr was significantly lower in patients with CHD than that in controls, the level of TBIL was significantly higher in patients with CHD than that in controls (P<0.01).The levels of Ccr were lower in two-vessel and three-vessel groups than that in controls (P<0.01), The levels of TBIL were higher in two-vessel and three-vessel groups than that in controls (P<0.05 or P<0.01).12. With the number of stenotic vessels increased, the rate of abnormal liver function increased(P<0.05).13. Multi-Logistic regression analysis showed that Ccr and TBIL were risk factors of CHD.14. With the increased BNP level, the level of LVEF was gradually decreased and the level of LVEDD was gradually increased (P<0.05或P< 0.01).15. With the increased BNP level, the level of Fib was gradually increased (P <0.05 or P<0.01).The levels of TG was gradually decreased(P<0.05).Conclusion:Lipid ratio has some clinical forecast value for CHD’s outbreak and severity. Both Hypertension and diabetes mellitus can affect lipid metabolism. CCr、TBIL、Lp(a) and Fib are closely related to the outbreak of coronary heart disease. The level of BNP had positive correlation with Fib, when the heart function of patients deteriorated, their blood was in hypercoagulability. While dealing with aged patients with coronary heart disease, it was important to view the situation as a whole, meanwhile focus on protecting each organ and system function and control the related risk factors. Only in this way, can we obtain satisfactory curative effects and improve the long-term prognosis.