Investgation On Serum Lipid Abnormality And Risk Factors Of Patients With Coronary Artery Disease

Objectives:Analyze lipids distribution of coronary heart disease patients according to the prevention and treatment guidelines of Chinese adults dyslipidemia.By studying the relation of lipid levels and the smoking,drinking,occupation, hypertension,diabetes and so on,in order to discuss how using lipids treatment can make CHD patients acquire more benefits.Methods:The study population consisted of 3400 patients with coronary heart disease who all come from Department of cardiology in second hospital of Tian Jin Medical University respectively from January,2000 to October,2008 and January,1980 to January,1989.Detailed information were collected,including sex,age,smoking history,drinking history,occupation,blood pressure,diagnosis and the collection of research subjects plasma glucose,insulin and blood lipid indicators,including TC,TG, HDL-C,LDL -C,VLDL-C.The data were divided into different groups with age, gender,coronary heart disease type,age and whether they have other risk factors combined to analyze and compare respectively according to the prevention and treatment guidelines of Chinese adults dyslipidemia.Result:3400 cases were inrolled,among which unstable angina patients is the most (44.47%),followed is acute myocardial infarction(23.88%),stable angina patients and old myocardial infarction accounted for 17.82%and 13.82%.1.The lipid characteristics of patients with coronary artery disease:coronary heart disease patients will be divided into two groups according to decades,the average age,TC levels,GLU levels,high blood pressure and diabetes prevalence rates of groupⅠwere higher than groupⅡ(P＜0.01).The SBP and DBP of groupⅠwere less than groupⅡ(P＜0.05,P＜0.01).TG levels between the two groups was no significant difference.The low HDL-C was common in today' s CHD patients and Increased TG was common in 20 years ago.From different groups of sex and age we can see that part of lipids level of all age groups was a significant difference.TG,TC, LDL-C,VLDL-C values of Male patients are the highest in the 50 to 59 group,TG, TC,HDL-C,LDL-C level of women patients were the highest in the 50-59 groups, blood lipids of male and female patients are declined with the age increasing.2.From different groups of case-control we can see that age and systolic blood pressure of control group were higher than the CHD group(P＜0.01).Diastolic blood pressure between the two groups were no difference.TG,TC,HDL-C and LOG(TG/HDL-C) level of CHD group were lower than the control group(P＜0.01);LDL-C,TC/ HDL-C and LDL-C/HDL-C level of CHD group were higher than the control group (P＜0.01);n-HDL-C of tow groups were no difference.The low HDL-C was common in CHD group accounting for 43.39%.Increased TG was common in control group accounting for 31.14%.analysis of CHD risk factor by Logistic regression we known that HDL-C is a protect factor,but TG,TC,LDL-C,n-HDL-C,TC/HDL-C, LDL-C/HDL-C and LOG(TG/HDL-C) are risk factors.3.blood lipid levels and dyslipidemia of different types coronary heart disease:the lipid levels of acute myocardial infarction,old myocardial infarction,unstable angina and stable angina patients are significant difference by one-way ANOVA(P＜0.01).the incidence of increased TG,increased TC,reduced HDL-C and increased LDL-C are significant difference(P=0.000,0.000,0.000,0.004);overall incidence rate was 56.89%, 63.07%,54.53%and 49.58%,There were significant differences(P=0.003). Reduced HDL-C is the most,while increased TC is the minimum in different types of patients with coronary heart disease.From the analysis of AMI subgroup we know that hospital mortality of AMI is degraded from 14.60%of 20 years ago to 9.19% now(P＜0.01).From different groups of blood lipid level we can see that:hospital mortality of AMI is raised with the lipid levels increasing.4.Blood lipid levels of simple coronary heart disease,coronary heart disease with hypertension,coronary heart disease with diabetes mellitus,coronary heart disease with hypertension and diabetes patients are significant difference by a single ANOVA(P＜0.01).the incidence of increased TG,increased TC,reduced HDL-C and increased LDL-C in every group are significant difference(P=0.000,0.001,0.000,0.049);overall incidence rates were 52.32%,53.08%,59.90%and 65.70%,four groups were statistically significant differences(P=0.000).5.Comparison of blood lipid in different level hypertension:blood lipid of normal blood pressure,hypertension grade 1,hypertension grade 2 and hypertension grade 3 are significant difference by one-way ANOVA(P＜0.01).The abnormal rate of TG and TC are significant differences(P values are 0.000,0.042,respectively),the abnormal rate of HDL-C and LDL-C are no differences(P=0.055,0.059,0.365).analysis of correlation between blood lipid and blood pressure we know that every lipid composition were positively correlated with the SBP and DBP,all have statistical significance.6.From different groups of different characteristics of the patients with coronary artery disease we can see that analysis of coronary heart disease risk factors which may affect the lipid levels by multivariate Logistic regression showed that male,drug, diabetes and hyperinsulinemia are risk factors of dyslipidemia(P＜0.01).Conclutions:According to the prevention and treatment guidelines of Chinese adults dyslipidemia,the levels and abnormality rates of blood lipid are high in coronary heart disease patients,and common in lowing HDL-C.Blood lipid levels are higher than 20 years ago,especially cholesterol,coincidence with morbidity of coronary heart disease,compared to the blood lipid of coronary heart disease patients in other regions and abroad with the same period,Tianjin is in the middle position.In addition to traditional indicators of blood lipid,n-HDL-C,TC/HDL-C, LDL-C/HDL-C and LOG(TG/HDL-C) to better guide prevention and treatment of coronary heart disease.There are different distribution of blood lipids in Coronary heart disease in patients with different types,analysis the relation of lipid levels and hospital mortality by AMI subgroup we found that hospital mortality of the higher TG, TC and LDL-C levels and lower HDL-C level of AMI patients are higher than the normal level.The point that Dyslipidemia are risk factors for coronary heart disease has been recognized and a lot of factors that would affect the lipid metabolism,the patients with risk factor should be taken to therapeutic lifestyle change measures when they are accepting drug treatment.