Investigation On Risk Factors Of Coronary Artery Disease And Two Years Follow Up By Therapeutic Life-style Change Treatment In Population Of Zhongshan City

Background and ObjectiveCoronary atherosclerotic heart disease referred to coronary heart disease is coronary atherosclerosis cause myocardial ischemia,a lack of oxygen caused by heart disease,atherosclerosis as the cause organ of the most common type of lesion.At present,epidemiological data indicate that the major risk factors for coronary heart disease are high blood pressure,smoking,diabetes and dyslipidemia,other coronary heart disease risk factors,including dietary factors,physical activity to reduce obesity,family history of coronary heart disease,age,gender,coagulation factors,high homocysteine levels,alcohol and mental factors.Most of these risk factors can interfere,especially dyslipidemia.Intervention on risk factors,early detection,intervention to conduct a comprehensive,integrated treatment,has been regarded as improve cardiovascular and cerebrovascular disease prevention and control of an important way to level.Lipid levels of our population and prevalence rate of dyslipidemia although lower than in most Western countries,but with the social and economic development, improve people's living standards and lifestyle changes,people on average lipid levels are gradually increased,as more and more many patients with dyslipidemia, the cause now and in the future will have an increasing number of coronary heart disease,stroke and other cardiovascular and cerebrovascular disease events.At present,dyslipidemia control situation is grim:cardiovascular disease,according to co-operation in Asia study estimates that at least one of our existing abnormal blood lipids 160 million people.Dyslipidemia such a large crowd now and in the future will inevitably bring about an increasing number of coronary heart disease,stroke and other cardiovascular and cerebrovascular disease events in our country to carry out prevention and treatment of dyslipidemia imminent.In addition to serum lipid concentration by genetic,gender,age and other factors difficult to change things,usually depends on the lipid metabolism directly with adjustable and changes related to factors such as diet,lifestyle and environment. Dietary factors are one of the most important.Lipid part of plasma from the food, and with changes in diet to increase or decrease.Diet on blood lipid levels has been a large number of experimental studies,epidemiological investigations,and clinical laboratory confirmed meals.Diet are the basis for the treatment of dyslipidemia. Groups so the community is in addition to dyslipidemia in patients with drug treatment,therapeutic lifestyle changes are aimed at people in the region's best selection of dyslipidemia,but also economic,security,high feasibility.Zhongshan City,not the past about the large-scale epidemiological risk factors for coronary heart disease research,has also been taken on the treatment of dyslipidemia in patients with a change of lifestyle research.Better for the crowd, Zhongshan City,including coronary heart disease prevention and treatment of dyslipidemia to provide a basis,through the investigation of this study in 2005, Zhongshan City,the heart of internal medicine patients and community groups and examination of the physical examination(including blood sugar,weight,blood pressure,blood lipids,smoking etc.),fill in the questionnaire at the same time, the population of the epidemiological risk factors for coronary heart disease research, for community groups to take the treatment of dyslipidemia change of lifestyle intervention and follow-up of two years and relevant data analysis. Methods1.Selection of targets and standards of elimination:(1) A total of 2690 inpatients in the cardiovascular department of 2 3A hospitals in Zhongshan City from Januray to April 2005 were chosen as samples,1800 from Zhongshan people's hospital,890 from Zhongshan boai hospital.Standared questionnaires were completed.99.7%responded.Eliminated patients include those who are suffering from hypothyroidism,nephritic syndrome or chronic renal insufficiency,chronic hepatic insufficiency,carcinoma or whose plasma lipid level is not determined.(2) A total of 2083 citizens were chosen by cluster sampling from January to April 2005,1650 from Zhongshan People's hospital,433 from Boai hospital.Data were collected by both body examination including plasma lipid,body weight, height,blood pressure,pulse,heart rate,electrocardiogram,chest x-ray etc and questionnaires were completed.97.42%responded.Eliminated people include those who are suffering from hypothyroidism,nephritic syndrome or chronic renal insufficiency,chronic hepatic insufficiency,carcinoma or whose plasma lipid level is not determined.2000 subjects were surveyed at last.(3) All 879 dyslipidemia patients received TLC and 2years' follow up..2.ContentsWith the method of cluster sampling and non-random sampling,this study covered inpatients and outpatient citizen from January to April 2005. Questionnaires were completed(a selection and training for investigators was conducted first) to know the general situation,eating habit and living habit, followed by plasma lipid levels,blood glucose,blood pressure,body weight, height,ECG,ultrocardiogram and etc.All outpatient citizens with dislipidemia were treated with TLC and followed up for 2 years.Lectures on health education were given every month to patients with different knowledge of plasma lipid.Four indices of plasma lipid were rechecked, recorded and analysed by SPSS 13.0 after 2 years.Diagnostic criteria1 Diagnostic criteria of dislipidemia:according to 2001 ATPⅢand 2004 ATPⅢs revise the report:patients who can meet one of the following can be diagnosed as dislipidemia sufferers:TC≥6.22 mmol/L,TG≥1.7 mmol/L,HDL-C＜1.04 mmol/L, LDL-C≥4.14 mmol/L.2 Diagnostic criteria of CAD:patients who can meet one of the following can be diagnosed as CAD sufferers:1) coronary angiography proves it is CAD;2) treadmill exercise test(TET) is positive;3) myocardial perfusion imaging(MPI) is positive;4) more than two precordial leads show Q wave and ultrasonic cardiogram indicates dysfunction of ventricular wall motion.CAD encompasses acute coronary syndrome (includes unstable angina and acute myocardial infarction),stable angina,old myocardial infarction,objectively proved myocardial ischemia,patients who have received percutaneous coronary intervention(PCI) and coronary heart bypass graft (CABG)(3).3 Coronary heart disease risk,such as the diagnostic criteria:is the non-coronary heart disease occurred in 10 years the risk of major coronary events in patients with coronary heart disease were the same,the new fat and recurrent ischemic events in cardiovascular disease risk of＞15%,the following are risk of coronary heart disease and other disorders:①There are clinical manifestations of coronary artery other than atherosclerosis:including ischemic stroke,peripheral arterial disease,abdominal aortic aneurysm and symptomatic carotid artery disease(such as short-term shortage of brain blood) and so on.②diabetes,its diagnostic criteria as follows:fasting plasma glucose≥7.0mmol/L,or oral glucose tolerance test(OGTT) plasma glucose two hours after≥11.1mmol/L;if two hours after OGTT plasma glucose≤11.1mmol /L,and≥7.8 mmol/L were defined as impaired glucose tolerance.③There are many risk factors for the occurrence of the risk of major coronary events equivalent to established coronary heart disease,myocardial infarction or coronary death of 10-year risk of＞20%.4 Diagnostic criteria of hypertension:based on average blood pressure levels measured repeatedly(twice or more) in a non-drug condition in different days, patients whose systolic blood pressure is 140 mmHg or above and/or diastolic blood pressure is 90 mmHg or above can be diagnosed as hypertension sufferers.5 Diagnostic criteria of overweight:Body mass index(bMI)=body weight (kg)/height~2(m~2)≥25kg/m~2.6 Diagnostic criteria of smoking:smoking more then 3 cigarettes everyday for at least3 years;exercise lovers:doing exercise more than 3 hours per week for at least 3 years.7 Diagnostic criteria of Vegetarian:According to international association, Vegetarian:is to do not eat meat,domestic fowl,fish and their by-products,can eat or do not suck at breast the ware with the egg;Carnivorous:Point the partial eclipse meat,and take a meal the≥3 times every week according to the edibility frequency,taking a meal larger than 300 grams each time.8 Exercise lovers:are those who exercise more than 3 hours every week,lasting for at least 3 years.Data processing and analysisEpidata3.0 software was adopted to build the data entry system.Formal data were entered twice by different people and were double checked one by one.After that,SPSS15.0 software was used to process the data.Standardized average values of the four indices were calculated.Continuous variables were expressed as mean value±standard deviation(SD),and homogeneity of variance test was made(P≤0.05 was considered equal variances not assumed).If equal variances were assumed,the comparison between two groups was made using 2 independent-samples t test,and One-Way ANOVA test was adopted to do significance tests in multi-groups (significance level≤0.05).If equal variances were not assumed,the comparison between two groups was made using t' test,and Kruskal-Wallis H was adopted to do significance tests in multi-groups(significance level≤0.05).Categorical variables were by number(%),the chi-square test was adopted to do significance tests (significance level≤0.05).Results1 Cardiac risk factors for coronary heart disease patients medical research:Cardiac risk factors for coronary heart disease patients of internal medicine for high blood pressure(62.02%),dyslipidemia(60.94%),overweight(38.3%), smoking(36.5%),diabetes or impaired glucose tolerance(13.16%).Coronary heart disease risk factors in the proportion of patients for hypertension(65.6%), dyslipidemia(64.2%),overweight(36.1%),smoking(29.9%),diabetes or impaired glucose tolerance(30.9%);non-coronary heart disease risk of patients factor ratio for hypertension(59.3%),dyslipidemia(58.4%),overweight(39.9%), smoking(41.64%),diabetes or impaired glucose tolerance(13.5%);overall patients abnormal blood lipid indicators increased for the TC(9.72%),TG increased (30.08%),HDL-C lower(44.72%),LDL-C increase(6.19%),mixed dyslipidemia (25.47%).2 Heart disease classification by medical inpatients survey Lipid Research:Heart medicine hypertension patients by disease sub-group,coronary heart disease, hypertension+CHD group,hypertension+heart disease+diabetes group,coronary heart disease and other risk groups,other group of six groups of cardiovascular diseases.Hypertensive group in which TC,LDL-C level of the highest,were 5.06 mmol/L,2.82 mmol/L;coronary heart disease risk group,such as the highest TG levels,and 1.83 mmol/L;hypertension+heart disease+diabetes group the level of HDL-C minimum,for 1.07 mmol/L.3 The community population studies of coronary heart disease risk factors: Community groups for coronary heart disease risk factors of dyslipidemia (43.95%),overweight(19.1%),smoking(4.5%),diabetes or impaired glucose tolerance(4.1%),hypertension(3.8%).Dyslipidemia 879 for the sick,the sick rate was 43.95 percent,higher TC abnormal blood lipid(12.9%),TG increased (27.65%),HDL-C lower(23.7%),LDL-C increased(3.7%),mixed dyslipidemia (20.35%).4 Dyslipidemia in patients with community groups and follow-up study of lifestyle intervention:Selected 879,the treatment of dyslipidemia after the number of patients dropped to 879 from 382,the overall treatment of patients after the standard rate of 56.64%; the treatment of dyslipidemia after the general decline in all indicators:TC increased to reduce the 171(19.45%),TG increased to reduce the 409(46.53%),HDL-C lowering to reduce the 310(35.27%),LDL-C increased to reduce the 63(7.17%); accounted for 97.38%of the low-risk community-based lifestyle intervention group TC,TG,HDL-C,LDL-C of the standard rate of 68.6 percent,respectively, 73.96%,67.09%,90.0%.Conclusion1 The risk factors of coronary artery disease are hypertension,dyslipidemia, overweight,smoking,diabetes or impaired glucose tolerance in hospitalized patients in the cardiology department of Zhongshan City People's Hospital.The proportion of high blood pressure,dyslipidemia,diabetes or impaired glucose tolerance in the group of patients with coronary artery disease are higher than in the group of patients without coronary artery disease(P＜0.01).2 In hospitalized patients of the cardiology department of Zhongshan City People's Hospital,the levels of TC,HDL-C,LDL-C are the highest in the group of hospitalized patients with hypertension,level of TG is the highest in the group of hospitalized patients with coronary artery disease risk,the level of HDL-C is the lowest in the group of hospitalized patients with hypertension,coronary artery disease and diabetes.As is Described above,the Dyslipidemia is closely related to hypertension,high blood glucose,and coronary artery disease.3 There are many risk factors of coronary artery disease in the community people in the city Zhongshan,such as dyslipidemia,overweight,smoking,diabetes or impaired glucose tolerance,hypertension.4 The lifestyle intervention achieved its desired effect in the community patients with dyslipidemia in zhongshan City,the blood lipids level in more than half of patients with dyslipidemia returned to normal levels of blood lipids through therapeutic life-style intervention.