Analysis And Intervention Status Of The Risk Factors Of Cardiovascular Disease In The Very Elderly With Coronary Heart Disease

Objective:1To analyse relativity between the very elderly coronary heart disease(CHD)and its some risk factors, such as age, sex, hypertension, dyslipidemia,smoking, diabetes, uric acid(UA), fibrinogen(FIB) and so on.2To screen out dominating risk factors correlated with the elderly CHD and toevaluate intervention status of the elderly CHD.Methods:1A total of353very elderly patients who were hospitalized in the GeriatricsDept of HeBei General Hospital during January2010to December2011weretaken as an object of studying.2A retrospective case-control study was applied to analyze its possible riskfactors by SPSS13.0for Windows statistical software with non-conditionalLogistic regression model.3To evaluate its main risk factors and intervention of very elderly patientswith CHD.Results:1The relationship between risk factors and CHD1.1Age and CHDThe prevalence ratio of patients with CHD aged in80～85years and overthe age of85were80.3%and89.9%.The prevalence rate of CHD increasedwith age. The prevalence ratio of patients with the old myocardial infarction(OMI) over the age of85was higher than aged in80～85years.1.2Gender and CHDThe prevalence rate of CHD was higher in male group than in femalegroup, but there was no statistical difference. Compared with female group with CHD, the prevalence rate of unstable angina pectoris (UAP) and OMIhigher in male group with CHD, but there was no statistically significant.1.3Hypertension and CHDThe prevalence ratio of CHD in hypertension group is higher than thenon-hypertensive patients. The systolic blood pressure (SBP) and pulsepressure (PP) of CHD group were higher than those of non-CHD group. Andthe ratio of stage3hypertension in CHD group is also higher than non-CHDgroup, especially in unstable angina pectoris group with statisticallysignificant differences.1.4Dyslipidemia and CHDThere was no significant difference about the ratio of CHD betweendyslipidemia group and non-dyslipidemia group. It was considered that mightbe caused by statins widely used. There had significant difference aboutlow-density lipoprotein (LDL-C), triglyceride (TG) and cholesterol (TC)levels between CHD group and non-CHD group. Except for the medicine, itwas also related to the lifestyle. The lifestyle of CHD group is better than thatof non-CHD group. The level of high-density lipoprotein(HDL-C) innon-CHD group was lower than CHD group, and there was no statisticalsignificance between the two group.1.5Smoking and CHDThe prevalence rate of CHD in smoking group and non-smoking groupshowed no statistically significant differ-ences. The possible causes might berelated to improved living habits of elderly people in long-term treatmentprocess, and most patients do not smoke for at least ten years and the effect ofsmoking on the cardiovascular was weakened than other risk factors.1.6Diabetes and CHDThe ratio of CHD in Diabetes mellitus (DM) group is higher than thenon-DM group. Compared with non-DM group, the ratio of UAP and OMI inDM group was higher, and there had statistical significance between them.The effective rate of diabetic patients was low, and blood glucose was stillcontrolled unsatisfactorily. 1.7Plasma fibrinogen and CHDThe plasma fibrinogen(FIB) levels of CHD group was higher than thatof non-CHD group, but there was no statistical difference. The plasma FIBlevel of patients with UAP and OMI were higher than other patients, but therewas no statistical difference either.1.8Serum uric acid (SUA) and CHDThe levels of SUA in CHD group was higher than in non-CHD group, theSUA levels of patients with UAP and OMI were higher than who with stableangina pectoris (SAP),but there was no statistical significance. Most of thehyperuricemia were untreated unless who with gout and other clinicalsymptoms.2Various risk factors and CHDSingle factor logistic regression analysis showed that: CHD with age,hypertension, diabetes, and LDL-C level was positively correlated,in whichLDL-C had the highest correlation(OR=12.537); and HDL-C level wasnegatively correlated with CHD (OR=0.023).Sex, UA, smoking and FIBwas no significant correlation with CHD; HDL-C was an independentprotective factor for CHD; and FBG, BP and LDL-C levels were independentrisk factors for elderly patients with CHD.3Clustering of risk factors and CHDThe constituent ratio of risk factors in different gender had no significantdifference. With the increasing in the number of risk factors in individualclustering, prevalence rate of CHD was on the rise. Multivariate logisticregression analysis showed that: CHD and the patient’s age, duration ofdiabetes, duration of hypertension, LDL-C level was significantly correlated;and was negatively correlated with smoking, sex, FIB and HDL-C relevance.The independent risk factors of the very elderly with CHD were age, diabetes,HBP and LDL-C and so on；the effects of the independent risk factors fromstrong to weak order: LDL-C, diabetes, hypertension and age.4The intervention status of various risk factorsAmong the alterable risk factors, smoking intervention was best, the second one was lipids; and FBG was the worst. Blood pressure ofhypertension in the very elderly was vulnerable to infection by the change ofbody position, and blood pressure control rate was still low. New risk factorssuch as UA and FIB didn’t have intervention. Aging was still a major riskfactor among unalterable risk factor. In terms of gender, pathogenesis of thefemale CHD patients were older than the male, but the complications andmortality of the female was higher than those male patients, and the number ofrisk factors was more than the male patients. In primary prevention, themutual trust must be built up between doctors and patients, and activelyintervene in risk factors to reduce the risk of cardiovascular disease.Compliance of drug therapy should be better administered in the secondaryprevention.Conclusions:1It was positively correlated with age, hypertension, diabetes, and LDL-Clevels in the elderly CHD risk factors in the study, in which the highestcorrelation of LDL-C and negatively correlated was HDL-C; sex, uric acid,smoking and FIB was no significant correlation; HDL-C was an independentprotective factor for CHD; FBG, age, hypertension and LDL-C level wereindependent risk factors for very elderly CHD patients.2Logistic regression analysis showed that: The independent risk factors of theelderly with CHD were age, diabetes, high blood pressure, LDL-C, and theeffects of the independent risk factors from strong to weak order:LDL-C,diabetes, hyper-tension and age.3Among the alterable risk factors, smoking intervention was best, the secondone was lipids; and FBG was the worst. Blood pressure of hypertension in thevery elderly was vulnerable to affect by the change of body position, andblood pressure control rate was still low. New risk factors such as UA and FIBdidn’t have intervention. Aging was still a major risk factor among unalterablerisk factor. In terms of gender, pathogenesis of the female CHD patients wereolder than the male, the complications and mortality of the female were higherthan those male patients, and the number of risk factors was more than the male patients.