The Construction Of Nomogram Prediction Model For The Risk Of Coronary Artery Disease In Menopausal Women And The Correlation Between TCM Syndromes

Objective:Systematic evaluation based on Meta-analysis to screen relevant fact ors affecting the onset of CAD in menopausal women,and to construct and valid ate the prediction model of the risk of CAD development in menopausal women and the prediction model of column line graph;To analyze and investigate the co rrelation between risk factors associated with CAD development and Chinese m edical evidence in menopausal women.Methods:1.Construction and validation of a Meta-analysis-based model for pre dicting the risk of CAD development in menopausal women:In this study,four f oreign electronic databases（Cochrane Library,Embase,Pub Med,and Web of Sc ience）and four Chinese electronic databases（China Knowledge Network,Wanf ang Database,China Biomedical Literature Database,and Wipu Database）were searched by computer to collect the published literature from the date of databas e construction to July 2022.English search terms include:Climacteric、Menopau se、Angina Pectoris、Coronary Disease、Myocardial Infarction、Risk Factors、Aff ected factors、Associated factor、Forecast factor、Causa.Frequency statistics and analysis of the included literature using Meta-analysis using Rev Man 5.4 softwa re,Calculation of the combined risk ratio OR for factors associated with the dev elopment of CAD affecting menopausal women,the statistically significant（P<0.05）factors were included in the construction of the logistic regression prediction model.The model was also externally validated using clinical data from 303 cas es of menopausal female patients hospitalized in the Department of Cardiology,Rui Kang Hospital,Guangxi University of Traditional Chinese Medicine,from S eptember 2017 to July 2022.The clinical data of the same patients as the validati on set were selected,and using R4.1.0 software,a column line graph prediction model was developed based on the predictors screened in the Meta-analysis,and internal validation was carried out.2.Correlation of risk factors associated with CAD development in menopausal women with TCM evidence:Including 90 men opausal female patients with confirmed CAD,and collect patients’general infor mation,comorbidities,laboratory tests,TCM main symptoms,tongue diagnosis,pulse diagnosis,TCM evidence type and other clinical information.Finally,to e xplore the correlation between each evidence type and clinical data.Results:1.A total of 34 papers from this study were included in the final Meta-a nalysis.The results of the study showed that comorbid diabetes,comorbid hyper tension,smoking history,BMI,family history of CAD,comorbid dyslipidemia,abdominal obesity,TC,LDL,MPV,PDW,and Lp-PLA₂,12 factors independent ly influenced the occurrence of CAD in menopausal women.A predictive model for the risk of CAD development in menopausal women was constructed as foll ows:Logit（P）=-0.26+0.61X₁+0.65X₂+0.88X₃+0.7X₄+0.87X₅+1.26X₆+0.20X₇+0.56X₈+0.27X₉+0.94X₁₀+1.13X₁₁+0.42X₁₂.The model was validated by plotting t he area under the ROC curve AUC and 95%CI of 0.630（0.560,0.700）,P<0.01,sensitivity of 0.553,and specificity of 0.713,for the 303 patients included.Sugg est that the prediction model has some predictive effect.Meanwhile,the clinical data of the above validation set of patients and the predictors screened in the Me ta-analysis were introduced into the R4.1.3 software,and draw a Nomogram pre diction model for the risk of CAD development in menopausal women.Conclusions:1.In this study,independent risk factors for the development of C AD in menopausal women were screened by means of Meta-analysis.This inclu des comorbid diabetes,comorbid hypertension,smoking history,BMI,family hi story of CAD,comorbid dyslipidemia,abdominal obesity,TC,LDL,MPV,PDW,Lp-PLA₂.2.In accordance with the Meta-analysis,we constructed a predictive model for the risk of CAD development in menopausal women.On this basis,a column line graph prediction model was performed based on retrospective hospi tal data.The predictive validity and reliability of the model were good,which he lps to predict the risk of CAD occurrence in menopausal women in clinical work and to assess further screening.3.The present study suggests that blood stasis an d phlegm may be more associated with the development of CAD in menopausal women when the actual signs of blood stasis and phlegm are obvious.4.This stu dy suggests that the higher the admission SBP and FBG levels and combined hy pertension,the more the diagnosis tends to be Qi deficiency and Blood stasis;th e higher the admission DBP,the more the diagnosis tends to be Qi stagnation an d Blood stasis.