The Relationship Between Serum Lipid Level And Degree Of Coronary Artery Stenosis In Elderly Patients With Acute Myocardial Infarction

Objective:With the gradual expansion of the global elderly population,the incidence of coronary heart disease(CHD)is increasing year by year.The elderly patients with CHD are often combined with other physical diseases.They need to take at least 7-8kinds of drugs orally every day.At present,some geriatrics experts have questioned whether the elderly(over 80 years old)need the same intensity of lipid-lowering treatment for CHD.China's 2016 clinical lipid-lowering guidelines still do not include age as a risk stratification factor.Studies on lipid-lowering intensity of the aged at home and abroad are relatively deficient.For 80 years old and above people,the relationship between blood lipid level with CHD whether no longer significant and need to actively lipid-lowering treatment remains controversial.There is insufficient research evidence on whether to relax the target value of fat reduction for the elderly.This topic research level and blood lipid levels in elderly patients with acute myocardial infarction(AMI)of coronary lesions,and analyzing the characteristics of the different age patients with AMI of blood fat,can further discuss the necessity and importance of blood lipid control in the elderly.Method:We selected the he patients with AMI(STEMI,NSTEMI)treated in the second hospital of tianjin medical university since January 2012 to May 2017.All patients included in the study were diagnosed with coronary angiography,and exclued some patients according to the exclusion criteria.All objects are divided into three groups according to age: group A(age < 65)and group B(?65 ~ < 80 years),group C(?80years old),in which A group is called the youth group,group B and C is called the elderly group.Clinical and laboratory data were collected and Gensini scores were calculated according to the international Gensini score standard.Statistical methods: 1)compare the blood lipid levels and Gensini scores in the three groups;2)compared the blood lipid level and Gensini integral difference between the three groups;3)using the method of linear regression and multivariate Logist regression analysis of blood lipidlevel and the degree of the coronary artery lesions(Gensini score)whether there is a correlation.Results:The elderly group had more female patients than the young and middle-aged group(P < 0.01).The incidence of hypertension and diabetes in the elderly group was higher than that in the young and middle-aged group(P < 0.01).The smoking and drinking rates of the young and middle-aged group were higher than those of the old group(P < 0.01).The incidence of hyperlipidemia(high TG,high TC,and high LDL)in the young and middle-aged group was higher than that in the old group,and there was a significant difference between the two groups(P < 0.01).The total cholesterol(TC),triglycerides(TG),low-density lipoprotein(LDL)and atherosclerotic index(LDL/HDL)of group A were higher than group B and C.TC,LDL/HDL levels in group A were significantly different from group B and C(P < 0.01).TG and LDL of group A were higher than group C and B,and there was statistically significant difference with group C(P < 0.05),but no statistically significant difference with group B(P > 0.05).The high-density lipoprotein(HDL)level of group C was significantly higher than group A and group B,and there was significant difference with group A(P < 0.01),while there was no statistical difference with group B(P >0.05).The HDL level of group B was higher than group A and there was significant difference(P < 0.01).The very low density lipoprotein(VLDL)level in group C was higher than that in group A and group B,but there was no statistical difference(P >0.05).With the increase of TC in group C,patients with CHD gradually aggravate,and Gensini score increases,both of which are positively correlated(P < 0.05).With the increase of TC and LDL,patients in group B gradually aggravate their CHD and increase Gensini score,both of which are positively correlated(P < 0.05).With the increase of TG and LDL,patients in group A gradually aggravate CHD and increase Gensini score,which are positively correlated(P < 0.05).The highest LYM% of group A was significantly different from group B and C.Group B had the highest NEU%,group A had the lowest NEU%,and there was statistical difference between group A and B,which was not statistically different from group C.Group B had the highestNLR,group A had the lowest NLR,there were statistically significant differences from group B and C,and there were no statistically significant differences between group B and C.Conclusion:The blood lipid distribution in AMI patients varies with ages.TC,TG,LDL and LDL/HDL level decreased with age.On the contrary,HDL and VLDL increase with age.The blood lipid level tends to be idealized with age increase,and the effect of high blood fat on CHD in youth patients is greater than in elderly patients.The severity and complexity of coronary artery stenosis increased with age.For AMI patients in different age groups,the components of blood lipid associated with Gensini score were different.For patients with age < 65 years,LDL and TG should be the achieved standard indicators for postoperative lipid-lowering therapy.In patients with age? 65~< 80 years,LDL and TC were used as the targets for postoperative lipid-lowering therapy.For elderly patients with age greater than 80 years old,the target value of lipid-lowering therapy should be referred to TC,rather than LDL.The main inflammation effects of AMI at different age stages were different.Humoral immune marked by lymphocyte may play a major role in the youth people with AMI,and cell immune marked by neutrophils is relative major in elderly with AMI.