Study On Correlation Between Syndrome Characteristic In Stable Coronary Heart Disease And Recurrent Cardiovascular Events

Objective: Analyzed on symptom, tongue condition, pulse condition and traditional Chinese Medicine (TCM) syndrome characteristic in stable coronary artery disease (SCHD) patients. Find out characteristic on TCM syndrome distribution. Explore TCM syndrome characteristic which have affect in SCHD and risk factors in recurring cardiovascular events.Method: Patients with SCHD in Xiyuan Hospital affiliated to China Academy of Chinese Medical Sciences, China-Japan Friendship Hospital, Anzhen Hospital affiliated to Capital University of Medical Sciences, Tongren Hospital affiliated to Capital University of Medical Sciences and Fujian Hospital of Integrated Chinese and Western Medicine from October,2007to December,2011. Used the prospective cohort study and combined with one year follow-up to analyze symptoms, tongue condition, pulse condition and TCM syndrome characteristics of SCHDpatients. Adopted single factoranalysis, logistic regression analysis, principal component Logistic regression and factor analysis.Results:Total of1503cases of CHD patients, male965cases (70.86%), female438cases (29.14%). maximum age is80years old, minimum is28years old, the average age is (62.01±9.27) years old. After one year face-to-face interviews and telephone follow-up,30cases (1.996%) patients had lost. Loss patients used the last datas as the outcome index.72cases (4.79%) recurred cardiovascular events, including unstable angina cured by revascularization22cases (1.46%), unstable angina hospitalized (not cured revascularization)27cases (1.8%), non-fatal myocardial infarction7cases (0.47%), cerebral infarctionll cases (0.73%), cardiac death cases (0.33%).TCM syndrome characteristic in SCHD patients showed:(according frequency from high to low):common symptoms are: coequal, tinnitus and deaf, backache, mouse dry with desire to drink, mouse dry without desire to drink, dizziness, spontaneousperspiration, chilly; Commen tougue color are: kermesinus, light dark, pompadour; Common tongue coating color are:white, yellow; Common coating natureare: greasy, thin, thick; Commen liguliform are: teeth-marked, plump, prick; Commen sublingual veins are:coarseexpansion, violaceous, varix; Common motility of tongue are:skew; Common plus condition:taut, deep, slippery, stringer; Common superficiality excess syndromes are:blood stasis, phlegm(partial hot), phlegm(partial cold); Common origin deficiency syndromes are:deficiency of kidney QI, deficiency of liver yin and kidney yin; deficiency of heart QI, deficiency of Qi; deficiency of heart QI+kidney QI, deficiency of kidney Yang.The sinle facor analysis of categorical data associated with cardiovascular events showed(according frequency from high to low): exfoliative fur of coating nature (not including similar exfoliative fur), moderate-severe asthma, moderate-severe bitter taste in mouth, blue or cyanotic tongue color, moderate-severe angina pectoris, moderate-severe stickiness in the mouth, tender liguliform, purple or dark reddish sublingual vein, diabetes history, unsatisfactory blood glucose or insulin therapy, tough liguliform, dark purple and ecchymosed tongue, frequent night maturation, teeth-marked liguliform, spontaneous perspiration, high TC hyperglycemia history, plump tongue, dizziness, CHD family history,hypertension history (2,3level), breathe hard, sports, severe palpitation had relationship wirh recurring cardiovascular events, Sports is negative correlation factor. The single factor analysis of measurement data display associated with cardiovascular events showed:high blood stasis syndrome score, high mainsyndromescorn, Hypersensitivity C-reactive protein(hs-CRP)≥3mg/dl, triglycerides (TG)≥2.26mmol/L, abnormal of lymphocytes percentage, hemoglobin decrease, blood sugarincrease had relationship with cardiovascular events.Logistic regression analysis showed factors associated with cardiovascular events as follows (according OR values from high to low):severe palpitations, exfoliative fur of coating nature (not including similar exfoliative fur),light white tongue color, serve bitter taste in mouth, angina predisposition(chill), tough liguliform, purple or dark reddish sublingual vein, tender liguliform, blue or cyanotic tongue color, blue or cyanotic tongue color, moderate-severe angina (blood stasis syndrome source), teeth-marked liguliform, fasting plasma glucose (BS)≥7.0mmol/L, CRP≥3mg/dl and high TC hyperglycemia history.The principal component Logistic regression on TCM syndrome in SCHD patients who recurred cardiovascular events showed:syndrome of cold congealing and syndrome of blood stasis have trend with recurring cardiovascular events, but did not reach statistical significance (P=0.073).Factor analysis on TCM syndrome in SCHD patients who recurred cardiovascular events showed:exfoliative fur of coating nature(not including similar exfoliative fur), skew tongue,shortening tongue, light white color tongue, kermesinus tongue color, light dark or lavender tongue color, several pulse, astringent pulse, irregularly pulse, halitosis, cough, expectoration, dreams had relationship with cardiovascular events.Conclusion:The main TCM syndromes in SCHD are deficiency in origin and excess in superficiality. Common superficiality excess syndrome are followed by: bloodstasis, phlegm(partialheat), phlegm(partialcold); Common originde ficiency syndrome are followed by:deficiency of kidney QI, deficiency of liver-yin and kidney-yin; deficiency of heart QI, deficiency of Qi; deficiency of heart QI+kidney QI, deficiency of kidney Yang.Relating factors with recurring cardiovascular events are: TCM: Symptom: severe palpitations, moderate-severe angina, angina predisposition(chill), moderate-severes asthma, breathe hard, dizziness, moderate-severe stickiness in mouth, serve bitter taste in mouth, frequent night maturation; Tongue condition: tough liguliform, teeth-marked liguliform, tender liguliform, blue or cyanotic tongue color, light white tongue color, exfoliative fur of coating nature(not including similar exfoliative fur), purple or dark reddish sublingual vein; Pluscondition: several pulse, astringent pulse, irregularly pulse; West medicine history: high TC hyperglycemia history, hypertension history, diabetes history; Biochemical indicators:BS≥7.0mmol/L, hsCRP>3mg/dl,TG>2.26mmol/L.Syndrome of cold congealing and syndrome of blood stasis may have some relationship with recurring cardiovascular events,combined with" blood-stasis and toxin causing catastrophe" hypothesis and Logistic regression analysis results showed that:Long stasis becoming toxin and cold congealing becoming toxin may one of the pathogenesis which SCHD of TCM transformation trigger to cardiovascular events.Kermesinus tongue color, light dark or pale or purple color tongue, exfoliative fur of coating nature(not including similar exfoliative fur), skew tongue, several pulse, astringent pulse, irregularly pulse halitosis showed stasis long becoming hot, hot and toxic intrinsic, gas consumption hurting Yin is another pathogenesis characteristics in SCHD recur cardiovascular events. These results suggested, blood stasis exist for long time may through hot and cold becoming toxic to lead to cardiovascular events may are the important pathogenesis in recurrent cardiovascular events. Enriched the development of toxin causing diseases catastrophehypothesis in SCHD.These are worth to study in further.