Retrospective Study Of Relationship Between Extent Of Coronary Lesions And Risk Factors And The Aggression

Objective:1.To investigate the relationship between common risk factors of coronary heart disease(CHD) and characteristics of injured coronary artery,and the relationship between the clustering of risk factors of CHD and coronary artery lesions.2.To study quantitative assessment of risk factors of CHD in evaluating severity and predicting occurrence rate of CHD for further prevention and treatment.Methods:1.We selected 2428 cases receiving coronary angiography(CAG).Patients′preprandial blood are tested by routine assay.The risk factors of CHD were compared with the results of CAG(positive rate),severity and extent of the coronary artery atherosclerosis(CAAS),and the relationship between each risk factor and the coronary artery obstructive score(CAOS) was analyzed through correlation analysis.We also used Logistic regression to analyze the risk factors of CHD.2.Risk factors of CHD above 2428 cases were summed up.The impact of the aggregation of individual CHD risk factors on the positive rate of CAG,severity and extent of the CAAS were compared,and the relationship between individual CHD risk factor aggregation and the CAOS,severity and extent of the CAAS were studied by correlation analysis respectively.3.According to some special standard,we selected 1502 cases from the above 2428 cases.The score of Framingham,PROCAM were performd respectively.The relationship between the two risk scores and the severity,extent of the CAAS and the CAOS was compared through correlation analysis.For further identifying the two risk scores which is more valuable in predicting the occurrence rate of CHD.Results:1.Each risk factor of CHD and coronary artery lesionAge and coronary artery lesionsThe positive rate of CAG,extent and degree of CAAS significantly increased with age increasing(P=0.000,0.000,0.000).In CHD patients,age of double-vessel disease(DVD) group and triple-vessel disease(TVD) group are significantly higher than that of group with single-vessel disease (SVD)(P=0.000),while the age of patients in severe stenosis is older than that in moderate stenosis patients(P=0.000).Gender and coronary artery lesionsThe positive rate of CAG in male is significantly higher than that in female(P=0.000).The proportion of multilesion and severe stenosis lesion are significantly higher in male than in female(P=0.000,0.000).Blood pressure and coronary artery lesionThe positive rate of CAG with hypertensive is higher than that with Non-hypertentive(P=0.003).Compared with that in Non-CHD group,the level of systolic blood pressure(SBP),diastolic blood pressure(DBP),pulse pressure(PP) in CHD group are higher(P=0.596,0.000,0.143).There is significant difference in PP among different extent of CAAS(P=0.018),while SBP,PP DBP have significant difference among different severity of CAAS(P=0.026,0.010,0.001).The level of SBP,DBP and PP in severe stenosis lesion patients are higher than that in moderate lesion patients.Moreover,PP is higher in TVD than in SVD patients.Blood lipids and coronary artery lesionsThere is no significant difference in the positive rate of CAG between hyperlipemia and Non-hyperlipemia(P=0.069),this may be related to the usage of statins.Compared with Non-hyperlipemia,the proportion of TVD and severe stenosis lesion in hyperlipemia are significantly higher(P=0.004,0.028).Being compared between CHD and Non-CHD group,the level of Low-density lipoprotein cholesterol(LDL-C) is higher,the HDL-C is lower,and both have statistic significance(P=0.003,0.000),but no difference in total cholesterol(TC) and triglyceride(TG)(P=0.262,0.802).In CHD groups,TC and LDL-C are increased significantly with the increasing of the lesion numbers(P=0.000),but do on the contrary with HDL(P=0.000).With the stenosis of CAAS increasing, the level of LDL-C increased gradually(P=0.003),while the level of HDL-C significantly decreased(P=0.000).The level of TC increaseing gradually with stenosis increased,but has no significant difference(P=0.559).Smoking and coronary artery lesion Compared with Non-smoking patients,The positive rate of CAG is significantly higher in the smoker(P=0.000),the proportion of TVD and severe stenosis lesion in the smoker are significantly higher(P=0.000,0.000).Diabetes and coronary artery lesionsThe positive rate of CAG in Diabetes mellitus(DM) patients is significantly higher than that in Non-DM group(P=0.000),and fasting plasma glucose(FPG) of CHD patients is significantly higher than that of Non-CHD patients(6.56±2.74vs5.57±1.29,P=0.000).In CHD patients,the DM has significantly higher proportion in severe stenosis,multiple vessles lesion(P=0.000,0.000),and had higher level of FPG(P=0.000,0.000).Serum Fibrinogen(Fg) and coronary artery lesionThe level of Fg in CHD group is significantly higher than that in Non-CHD group(P=0.031).In CHD patients,the levels of Fg in patients with TVD and severe stenosis lesion are higher,but has not statistic difference (P＞0.05).Serum uric acid(UA) and coronary artery lesionsThe concentration of UA in CHD group is higher than that in Non-CHD group(P=0.004).Among the CHD groups,the concentration of UA in TVD and severe stenosis lesion patients are significantly higher(P=0.013,0.003).1.9 Correlation analysis between each risk factor of CHD and CAOS and logistic regression analysis on risk factors of CHD.CAOS has positive correlation with hypertension,smoking,DM,age,SBP, PP,Fg,UA,FPG,TC and LDL-C respectively,has negative correlation with female,HDL-C respectively.And among them,the age has the most strong correlation(r=0.255,P=0.000).Being caculated by logistic regression analysis,the independent protecting factors of CHD are female,HDL-C,and age,FPG,IR,smoking,LDL-C are the independent risk factors of CHD.2.Clustering of risk factors in CHD and coronary artery lesionsThe proportion of gender that show clustering of risk factors in individuals are statistical difference.The Proportion that have more than four risk factors in male is higher than that in female. With the number of risk factors clustering in individuals increased,the positive rate of CAG,extent and severity of CAAS are gradually increasing.The number of risk factors clustering in individuals has significantly positive correlation with CAOS,extent and severity of CAAS respectively.3.Quantitative assessment of risk factors of CHD and coronary artery lesionsBoth Famingham risk scores and PROCAM risk scores significantly correlates with CAOS,extent and severity of CAAS respectively.After being compared the two scores,we find that the correlation of Famingham risk scores is higher than that of PROCAM risk scores.Risk scores increased with the severity of coronary artery pathological change advancing.The areas under of resident operation character(ROC) of Famingham risk scores and PROCAM risk scores,which,for predicting the incidence of CHD,are 0.576,0.676 respectively,and the former is higher than the latter.Conclusions:1.Female,HDL-C are the independent protecting factors for CHD and the independent risk factors are age,FPG,IR,smoking and LDL-C.Significantly positive correlation was founded between CAOS and hypertension,smoking,DM, age,SBP,PP,Fg,UA,FPG,TC and LDL-C and CAOS had negative correlation with female,HDL-C.2.The clustering of risk factors is associated with positive rate of CAG,the extent and severity of CAAS.The more the clustering of risks presented,the more severity of the CHD.3.Two risk scores,Famingham risk scores and PROCAM risk scores,could be used to evaluate the severity of CAAS and predict incidence of CHD. Famingham risk scores is better.