Multivariate Analysis Of Risk And Prognostic Factors In Patients With Coronary Heart Disease

Background Coronary heart disease(CHD)has complex physiological and pathological process,which is considered to be the result of the interaction of genetic and environmental factors,and is also related to age,smoking,diabetes,hyperlipidemia,hypertension and some other risk factors.Our study aimed to evaluate the risk factors that may trigger CHD and affect prognosis by retrospective analysis,so as to play a positive role in the prevention and treatment of CHD.Methods Patients who has been examined by coronary angiography in the department of cardiology,Rui Jin Hospital,Shanghai Jiao Tong University School of Medicine in 2009 were included in our study.We recorded all selected patients' general,laboratory,imaging,and medication data.Patients with CHD have been followed up for 6 years by telephone or hospital readmission through questionnaire.The endpoint was defined as major adverse cardiovascular events(MACE).All collected data were analyzed by software SPSS 22.0.Logistic and Cox regression analysis were used to evaluate the risk and prognosis factors of CHD.Results Among all 756 patients,576 were diagnosed as CHD,180 were not.Logistic regression analysis showed that male was more likely to have CHD then female(P=0.004,RR=1.972,95%CI: 1.240-3.138);Age,smoking,TC,and Scr were positively correlated with CHD(P=0.003,RR=1.371,95%CI: 1.115-1.686 ? P=0.01,RR=1.923,95%CI: 1.168-3.165?P=0.034,RR=1.238,95%CI: 1.016-1.509?P=0.02,RR=1.138,95%CI: 1.021-1.269);while HDL-C levels showed negative correlation with CHD(P=0.013,RR=0.448,95%CI:0.239-0.842).576 CHD patients were followed-up for mean 63.32±26.35 months.There were 224 MACE occurred.Cox regression analysis showed that high DBP,aged,history of myocardial infarction and diabetes mellitus may increase the risk of MACE(p=0.050,HR=1.145,95%CI: 1.000-1.312;p=0.046,HR=1.197,95%CI: 1.003-1.428;p=0.024,HR=1.401,95%CI: 1.046-1.877;p<0.001,HR=1.824,95%CI: 1.370-2.429),while antiplatelet therapy and high eGFR may reduce the risk of MACE(p=0.024,HR=0.713,95%CI: 0.532-0.956,p=0.025;HR=0.903,95%CI: 0.825-0.987).Conclusion The incidence and prognosis of CHD are associated with multiple risk factors.Men,smoking,aged,high TC,high Scr are the risk factors of CHD,while HDL-C may be a protective factor to reduce the risk of CHD.Furthermore,High DBP,aged,history of myocardial infarction and diabetes mellitus may increase the long-term risk of MACE,while standard antiplatelet treatment and high eGFR may improve the prognosis of the CHD patients significantly.Therefore,for patients with high risk of CHD,blood pressure,glucose,lipids and smoking should be controlled strictly according to the guideline.Meanwhile,the CHD patients should insist standard antiplatelet therapy,and their renal function should be concerned at the same time as it may be an important factor in the long-term prognosis of CHD.