Distribution And Clustering Status Of The Risk Factors For Premature Severe Three-vessel Coronary Disease

Objective:In recent years, incidence of coronary heart disease (CHD) tends increasing trend. It has been a main disease threatening the public health. The onset of CHD is earlier and the extent of coronary artery lesions is severer with the changing of modern life style. Severe three-vessel coronary artery lesion is the main cause for the end-stage heart failure, which brings tremendous economic burden for the society and the individual. Studies about epidemiologic features of risk factors of premature severe three-vessel coronary artery lesions were fewer.This study is to analyze the contribution and clustering of the risk facors for the premature severe three-vessel coronary artery lesions, and to provide the evidence for prevention of the premature CHD patients.Methods:Consecutive cases of hospitalized patients for CHD were collected at the Second Hospital of Tianjin Medical University during March 2009 to March 2011. All cases accepted coronary angiography. The criteria for premature severe three-vessel coronary artery lesions group included:(1) the onset age of CHD for male is less than 55 years old and for female is less than 65 years old; (2) severe three-vessel coronary artery lesions indicates the area stenosis of LAD, LCX, RCA or LM, RCA is more than 75 percent according to quantitative coronary angiography; The criteria for normal coronarography is that three coronary arteries are smooth without narrow or expansion; 339 cases for premature severe three-vessel coronary artery lesions and 181 cases for normal coronarography were included in the study. For all selected patients, medical history including gender, age, smoking, drinking alcohol, hypertention, diabetes mellitus (DM), positive family history (PFH) of CHD and so on were taken and body mass index (BMI) was measured. Routine blood cell test, blood coagulation and renal functions were measured at the moment of admission. At the next morning of admission peripheral venous blood was taken for the measurement of blood lipids, C reactive protein (CRP) and liver function. Routine examination of the echocardiography was performed. SPSS11.5 was used for statistical processing of data.Results:(1) There were significant difference in ratios of male, smoking, hypertension, DM, PFH of CHD, metabolic syndrome and the value of triglyceride, high-density-lipoprotein-cholesterol(HDL-C), BMI, uric acid, PLT, WBC, fibrinogen and CRP between groups(P< 0.05). Multiple logistic regression analysis showed that male, PFH, DM, obesity, low HDL-C level, high levels of low-density-lipoprotein-cholesterol (LDL-C) and triglyceride were risk factors for premature severe three-vessel coronary lesions. (2) The distribution of risk factors was different between disease group and control group. The ratio of patients with more than 3 risk factors was higher(78.8% vs 25.4%), and the ratio of patients with less than 3 risk factors was lower(2.6% vs 49.2%) in disease group than that in control group(P<0.01).(3) Subgroup analysis indicated that smoking, PFH, BMI, HDL-C, LDL-C were significantly different between male patients in disease group and male subjects in normal group. However, PFH, BMI, HDL-C, DM, hypertention, triglyceride were significantly different between female patients in disease group and female subjects in normal group(P< 0.05).Comparion of risk factors for two genders in the disease group showed that the ratios of smoking and PFH were higher in male disease group and the ratios of DM, hypercholesterolemia and hypertriglyceridemia were higher in female disease group(P<0.05).The proportion of risk factor number above three in male disease group was higher than female disease group(90.8% vs 38.5%).(4) Triglyceride level was higher and HDL-C level was lower in disease group with hypertention or DM or obesity or smoking than in control group with hypertention or DM or obesity or smoking(P<0.01).(5)Subgroup analysis showed that duration of diabetes, BMI, CRP, PLT and serum creatinine level was higher in LVEF reduction group(LVEF<50%) than LVEF normal group(LVEF≥50%) in patients of premature severe three-vessel coronary artery lesions(P<0.05). Multiple logistic regression analysis showed that duration of diabetes, obesity and serum creatinine level were predictors for LVEF reduction.Conclusion:(1) Male, PFH, DM, obesity, high LDL-C, low HDL-C and hypertriglyceridemia were independent risk factors for premature severe three-vessel coronary artery lesions. (2) Clustering of the main risk factors of CHD existed in the premature severe three-vessel coronary artery lesions and clustering extent of any three risk factors or more was significantly higher.(3) Risk factors were significantly different between two genders. DM, hypertriglyceridemia and hypercholesterolemia was significantly associated to female, while smoking and PFH was significantly associated to male. The clustering extent of risk factors was higher in male group.(4) The level of triglyceride was higher and the level of HDL-C was lower in patients with hypertention or DM or obesity or smoking of disease group than those subjects of normal group. (5) The risk factors associated with LVEF reduction in patients of premature severe three-vessel coronary artery lesions were duration of diabetes, obesity and high-creatinine.