| BackgroundCoronary heart disease (CHD) namely, Coronary atherosclerosis heart disease, is the frequently-occurring disease in our country, it is also one of important reason that resulted in the deaths of patients. Conventional idea suggests, that incidence of females coronary heart disease are later10to20years than men. However epidemiology investigation shows that the developed countries male coronary heart disease mortality decreased obviously, while women were on the rise. CHD has become the number one killer of women’s health. Epidemiological investigation has confirmed, the incidence of coronary heart disease in premenopausal women is10%to30%for men, postmenopausal rise rapidly, reached a peak at the age of55-70years, there was no evident difference with men, and so the older women CHD become a research hotspot in coronary heart disease, but its pathogenesis is still not completely clear.Homocysteine (Hcy) is2-amino-4sulphur butyric acid, is a product of methionine metabolism in the body. At home and abroad a large number of studies have shown that Hcy is a risk factor for coronary heart disease, and with the age increased, median of plasma Hcy levels had increased. Research shows that Coronary heart disease (CHD) relate to the inflammatory response, High homocysteine can lead to endothelial injuries, lead to atherosclerosis, and it can affect platelet function, promote the arterial thrombosis. It can be speculated that high homocysteine easily lead to coronary heart disease in elderly women. Studies have found that hypertension and high Hcy can cause vascular endothelial cell injury and cause platelet gather in the place of endothelial cell damaged, cause form of thrombosis riching in platelet. At the same time, the injury of vascular endothelial cells can cause the imbalances of endothelial diastolic factor and shrinkage factor, cause the further rising of blood pressure. Still can reduce secretion of enzymes relating Hcy metabolism, to further make the Hcy levels elevate, Both promote each other to injure vascular endothelial cell, form a vicious circle, accelerate hardening of the arteries. Associated with elevated plasma homocysteine of primary hypertension is called H-type hypertension. H-type hypertension is the superposition of high Hcy and the hypertension, Through the local and systemic inflammatory response to injure endothelial cells and increased incidence of cardiovascular, So in patients with H type hypertension, blood vessel damage degree would be even greater.Coronary heart disease includes stable angina pectoris and acute coronary syndrome(ACS), The pathogens of ACS is appearing vulnerable plaques (VP) of cracks, erosion and fracture, secondary thrombosis based on the lesions of coronary atherosclerosis, and involving vascular spasm factors, and vulnerable plaque rupture has significant relationship with inflammatory response, So the H-type hypertension may have a close relation with the incidence of acute coronary syndrome, So based part in antihypertensive drugs by lowering homocysteine may help to reduce response of H-type hypertension to inflammation of the blood vessels, and has special significance to the prevention of older women coronary heart disease.ObjectiveThis study intended to investigate the relationship between the H-type hypertension and elderly women coronary heart disease by measuring the blood pressure and plasma homocysteine, combined with coronary angiography to patients. Methods419older women patients suspected coronary heart disease, diagnosised of hypertension admitted and treated in the First Affiliated Hospital of Zheng Zhou University from June2010to June2012were selected. All of the patients were performed coronary angiography.1. According to the [28]2006stroke prevention and treatment guidelines, settedHcy≤10umol/L as normal, the Hey>10umol/L as high Hey, according to different levels of homocysteine (Hey), they were divided into the H-hypertension group (Hcy≥10μmol/L) with321patients and the simple hypertension group (Hcy<10μmol/L) with98patients. Compare the proportion of coronary heart disease patients and general messages between H-type hypertension group and simple hypertension group.2. According to the coronary angiography results, there was325cases had been diagnosed coronary heart disease, According to the different coronary lesions, they was confirmed single lesion group (122cases), double lesions group (115cases) and multivessel lesions group (88cases), Compared the patient’s general condition, H-type hypertension patients proportion and the Hey levels among different groups.3. According to the results of coronary angiography, quantitatived assessment of coronary vascular lesion severity stenosis in patients with coronary artery disease using Gensini score system, Compared coronary artery Gensini score between H-type hypertension group (265cases) and simple hypertension group (65cases), and explored the correlation between Hey level and coronary artery Gensini score.4. According to the clinical manifestations, patients were divided into SAP group (190cases), the UAP group (91cases) and AMI group (44cases); compared coronary artery Gensini score, Hey level and proportion of H-type hypertension patients among different groups.5. Screening the risk factors for older women coronary heart disease by Logistic regression analysis.All statistic work was carried out with SPSS15.0. The measurement data were shown by (mean±SD).Statistic analysis among groups was performed by analysis of t-test. The enumeration data were shown by rate, the rate of analysis between groups was performed by chi-square test. The relationship between variables was analyzed by Spearman rank correlation. Multi-factor analysis was analyzed by Logistic regression analysis. A value of P<0.05was considered statistically significant. Results1The general clinical data including age, smoking, history of diabetes, blood lipid and body mass index, etc were no significant difference between H-type hypertension group and simple hypertension group (P>0.05).2. The percentage of coronary heart disease (CHD) patients (81.93%) in H-type hypertension was significantly higher than that in the simple hypertensive group (65.30%), there were statistically significant difference (P<0.05).3. Hcy levels in the coronary multivessel lesions group, double lesions group, single lesion group and normal control group, respectively were (19.08±5.87) umol/L,(17.05±5.58) umol/L,(13.68±5.44) umol/Land (12.60±5.26) umol/L. The Hcy level of Multivessel lesions was significantly higher than that in the control group (P<0.01),and significantly higher than that in single lesion group (P<0.05), compared with the double lesions group, there was no significant difference (P>0.05); The Hcy levels of double lesions group and normal control group were significantly higher than that in normal control group (P<0.01), there was no significant difference compared with single lesion group (P>0.05), There was no significant difference between single lesion group and the control group (P>0.05); The proportion of H-type hypertension in multivessel lesions group was significantly higher than that in single lesions group (P<0.01) and normal control group (P<0.01), The proportion of H-type hypertension in double lesions group was significantly higher than it in single lesions group (P<0.01) and normal control group (P<0.01), there was no statistical significance (P>0.05) between multivessel lesions group and double lesions group, and there was also no statistical significance (P>0.05) between single lesions group and normal control group, but it showed a trend of increase.4. The Gensini score (52.46±27.29) of coronary heart disease (CHD) patients in H-type hypertension were significantly higher than that (42.42±21.84) in simple hypertension group, there were statistically significant difference (P<0.05).5. The mean levels of serum Hey were (15.72±6.04) umol/L,(17.55±5.85umol/L),(17.65±6.01) umol/L, respectively in SAP, UAP and AMI group. The levels of serum Hey were obviously higher in UAP and AMI groups than in SAP group with significant difference (P<0.05), There were no statistically significant difference between AMI group and UAP group (P>0.05).The prevalence rates of H-type hypertension were76.32%,84.62%,88.64%, respectively in SAP, UAP and AMI group, there were no statistically significant difference between UAP and AMI group (P>0.05), The prevalence rates of H-type hypertension in UAP group were higher than in SAP group, there were significant difference (P<0.01), The prevalence rates of H-type hypertension in AMI group were higher than in SAP group,there were significant difference (P<0.05).6. The level of serum Hcy was positive correlation with coronary Gensini score.7. Logistic regression analysis conducted in patients with CHD diagnosed by CAG, whether there will be CHD as a result of variables, setted age、smoking history、diabetes、history of H-type hypertension、TC、TG、HDL、LDL、LP(a) as the Covariate for the Logistic regression analysis, the results showed that H-type hypertension was an independent risk factors for coronary heart disease (P<0.05).Conclusion1. H-type hypertension is closely related to the elderly women coronary heart disease. The levels of Hcy and H-type hypertension are associated with severity of coronary artery in patients with coronary artery disease.2. H-type hypertension and Hcy are associated with the instability of coronary artery plaque, it shown the Hcy and H-type hypertension are associated with vulnerability of plaque. |
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