The Correlation Between The Progress And The Changes In Risk Factors Of Coronary Artery Disease

Coronary artery angiography (CAG) as a "gold standard" diagnostic criterion of coronary heart disease (CHD), has been extensively developed in the clinical work. Accroding to the clinical status, some patients may need more than once CAG during the follow-up.In numerous studies always, without exception, confirmed that statins are the most effective drug in lowering the levels of LDL-C, at the same time, can significantly reduce CVD events.2013 ACC/AHA lipid management guidelines fully stressed that effectively reduce LDL-C is to reduce arteriosclerotic cardiovascular disease (ASCVD) events.A growing number of studies found that HbAlc also has close relationship with CVD events. Meta-analysis showed that, no matter in diabetic and non-diabetic patients, every 1% increase CVD in HbAlc is associated with increasingCVD event rate by 10% to 20%. Age, gender, BMI, smoking history, history of hypertension and diabetes are associated with the development of CHD.However, previous studies paid few attention to the relationship between coronary lesion progress and the change in risk factors.This thesis tries to discuss the following questions:1, what are the role of risk factors of baseline and the changes in the progression of coronary artery lesions-,2, Is there any differences in risk factors and the changes of risk factors for coronary artery atherosclerosis progression between patients with diabetes and non-diabetes?Part I:The association between CAD progression and the changes in risk factorsObjective:To analysis the correlation between risk factors and progression of coronary artery diseaseMethods:This is a retrospective analysis on single center clinical data. The data of the patients undergoing coronary for the first time during 2010. l-2011.6 and accepted the second coronary angiography during 2010.7-2012.9 at the cardiology division, huashan hospital of fudan university were collected. The Gensini score was used to assess the severity of CAD. The CAD progression was defined as the increase of the Gensini score in the second CAG compared with the first CAG. All patients were divided into two groups. We compared the clinical data between two groups, using the single factor analysis method to analyze the relationship between the risk factors and coronary artery lesions in progress, using binary classification Logistic multifactor regression analysis to analyze the relationship between the risk factors, changes in risk factors and coronary artery lesions in progress respectivly. The intervals between first and second CAG were from six months to 26 months, the median interval was 16 monthsResults:A total of 350 patients were included, mean age 67.6+/-10.5 years, among them 239(68.3%) cases were male.198 patients were found a CAD progress in second CAG from the baseline, progress rate of 56.6%. Compared with the non-male patients (p< 0.001), with hypertension (p= 0.006), with history of myocardial infarction (p= 0.009), the mean systolic blood pressure was higher (p= 0.037). There are higher levels of the biochemical data of patients admitted TC, LDL-C, HbA1c, and HDL C in the progress group than the non-progress group (p< 0.001), when the patients undergoing second CAG. Single factor analysis found that male(p < 0.001), baseline mean systolic blood pressure (p= 0.041), the second hospital of TC (p< 0.001), LDL-C (p< 0.001), HbAlc (p-0.001) and the HDL-C level (p= 0.001) were risk factors for CAD progress. The changes in the TC (p< 0.001), LDL-C (p< 0.001), HbAlc (p< 0.001), and non-HDL cholesterol (p< 0.001)were risk factors for CAD progress. After adjustment gender, age, smoking, hypertension, BMI and eGFR. HbA1c and LDL-C change are still the independent risk factors for the coronary atherosclerotic plaque progression, the every 10% rise than baseline level of HbAlc and LDL-C, corresponding RR were 1.332 (95% CI:1.127, 1.575),1.219 (95% CI:1.110,1.339).Conclusion:The increase in LDL-C, HbAlc were independent risk factors for coronary artery disease progress.Part II:The association between CAD progression and the changes in risk factors in diabetic patientsObjective:To analysis the correlation between risk factors and progression of coronary artery disease in diabetic patients.Methods:The cases of this study were diabetic patients from Part I. The research methods were same with Part I. The intervals between first and second CAG were from six months to 25 months, the median interval was 16 monthsResults:A total of 216 patients were included, mean age 66.8+/-10.6 years, among them 140(64.8%) cases were male.129 patients were found a CAD progress in second CAG from the baseline, progress rate of 59.7%. Compared with the non-smoking patients (p< 0.001), with hypertension (p= 0.001), with history of myocardial infarction (p= 0.005), the mean systolic blood pressure was higher (p= 0.024). There are higher levels of the biochemical data of patients admitted TC, LDL-C, HbAlc, and HDL-C in the progress group than the non-progress group (p < 0.001), when the patients undergoing second CAG. Single factor analysis found that smoking(p=0.032), baseline mean systolic blood pressure (p = 0.031), the second hospital of TC (p< 0.001), LDL-C (p< 0.001), HbAlc (p< 0.001) and the HDL-C level (p< 0.001) were risk factors for CAD progress. The changes in the TC (p< 0.001), LDL-C (p< 0.001), HbAlc (p< 0.001), and non-HDL cholesterol (p< 0.001)were risk factors for CAD progress. After adjustment gender, age, smoking, hypertension, BMI and eGFR. HbAlc and LDL-C change are still the independent risk factors for the coronary atherosclerotic plaque progression, the every 10%rise than baseline level of HbAlc and LDL-C, corresponding RR were 1.298 (95%, CI:1.083-1.555),1.295(95%, CI:1.148-1.460).Conclusion:The increase in LDL-C, HbAlc were independent risk factors for coronary artery disease progress in diabetic patients.Part III:The association between CAD progression and the changes in risk factors in non-diabetic patientsObjective:To analysis the correlation between risk factors and progression of coronary artery disease in non-diabetic patients.Methods:The cases of this study were diabetic patients from Part I. The research methods were same with Part I. The intervals between first and second CAG were from 7 months to 25 months, the median interval was 15 monthsResults:A total of 134 patients were included, mean age 68.8+/-10.4 years, among them 99(73.4%) cases were male.69 patients were found a CAD progress in second CAG from the baseline, progress rate of 51.5%. Compared with the non-male patients (p< 0.001).There are higher levels of the biochemical data of patients admitted TC (p<0.001), LDL-C (p<0.001), HbAlc (p=0.019), when the patients undergoing second CAG. Single factor analysis found that sex (male) (p=0.032), the second hospital of TC (p < 0.001), LDL-C (p< 0.001), HbAlc (p=0.024) were risk factors for CAD progress. The changes in the TC (p= 0.001), LDL-C (p= 0.022), HbAlc (p< 0.001), and non-HDL cholesterol (p< 0.001)were risk factors for CAD progress. After adjustment gender, age, smoking, hypertension, BMI and eGFR. HbAlc and LDL-C change are still the independent risk factors for the coronary atherosclerotic plaque progression, the every 10% rise than baseline level of HbAlc and LDL-C, corresponding RR were 2.387 (95%, CI:1.165-4.890),1.053 (95%, CI:1.025-1.369)Conclusion:The increase in LDL-C, HbAlc were independent risk factors for coronary artery disease progress in non-diabetic patients.