A Study Of The Risk Factors Of Coronary Heart Disease In Postmenopausal Women

Objectives:With the concern of women's health,it is gradually recognized that coronary heart disease will also have a serious impact on women.The symptoms of female angina pectoris are often atypical and diverse,with certain particularity,and it is easy to miss diagnosis and misdiagnosis.According to the data of American Heart Disease and stroke in 2014,coronary heart disease is the main cause of female death,but there are few researches on female coronary heart disease in China.Therefore,the diagnosis of female coronary heart disease was confirmed by coronary angiography,radionuclide myocardial perfusion imaging,and the detection of clinical biochemical and ultrasonic indexes;To explore To explore the risk factors of coronary heart disease in postmenopausal women,and analyze the influence and correlation among the factors;It provides a certain clinical basis for identifying high-risk groups,improving the diagnosis and treatment of female coronary heart disease,and early intervention of incidence rate.Methods:1.Case control study was used.From January 2016 to January 2017,129 female inpatients from cardiovascular department of Zibo Mining Group Central Hospital were collected(1)Inclusion criteriaKeywords postmenopausal female patients;with chest pain,chest distress symptoms;resting ECG with ST-T changes;(2)Exclusion criteria:Congenital heart disease,valvular heart disease,myocarditis,various types of cardiomyopathy,aortic dissection,pulmonary embolism,pulmonary and pleural diseases,gastroesophageal diseases,bundle branch block,electrolyte disorder,tumor and blood system diseases,rheumatic immune system diseases,recent trauma and cardiac surgery2.(1)All the selected patients received fasting blood sampling the next day after admission,and the relevant laboratory indexes were tested;(2)To improve the carotid ultrasound measurement and Doppler echocardiography;(3)Myocardial perfusion load imaging was performed in patients with coronary stenosis less than 50%;(4)The ambulatory myocardial perfusion rest imaging was performed in patients with positive load imaging;(5)Patients with myocarditis,cardiomyopathy,valvular disease,aortic dissection,gastroesophageal disease,bundle branch block and electrolyte disorder were excluded.According to the results of CAG and nuclide myocardial perfusion imaging,the patients were divided into three groups:non-coronary heart disease group(coronary normal group),coronary microvascular dysfunction(CMVD)group and coronary disease group.3.Record the patient's general information(including age,height,weight,diabetes and high blood pressure,etc.),laboratory indexes(routine blood,fasting blood glucose,blood lipid,hepatic function,renal function,hypersensitivity,c-reactive protein,etc.)imaging results and analyze the dataResults:In this study,129 postmenopausal women with chest pain were enrolled.There was no statistical difference in the sex ratio.They were 42-83 years old and had no habit of smoking or drinking.There were 34 cases of non-coronary heart disease,66 cases of coronary artery disease and 29 cases of CMVD.1.Nineteen of the 20 indexes of the three groups were obtained by one-way ANOVA(excluding carotid plaque):1.1 There were no significant difference in 8 indexes,including body mass index(BMI),diastolic blood pressure(DBP),white blood cell count(WBC),hypersensitive C-reactive protein(hs-CRP),triglycerides(TG),uric acid(UA),thyroid stimulating hormone(TSH)andLeft atrium(LA)(P>0.05);There were statistical differences in 11 indexes,including age,systolic blood pressure(SBP),red blood cell distribution width(RDW),fasting plasma glucose(FPG),total cholesterol(TCH),low density lipoprotein cholesterol(LDL-C),homocysteine(Hey),estradiol(E2),carotid intima media thickness(IMT),left ventricular size(LV),ejection fraction(EF),P<0.05.1.2 For 11 indexes with statistical difference,LSD test was used for comparison between groups1.2.1 Comparison between coronary disease group and non coronary disease group:there are statistical differences in 8 indexes,including SBP,RDW,FPG,TCH,E2,Hey,LV,EF values,P<0.05;1.2.2 Comparison between CMVD group and non coronary heart disease group there were statistical differences in four indexes,namely,TCH,RDW,Hey,IMT,P<0.05;1.2.3 Compared with CMVD group,there were statistically significant differences in 5 indexes:age,SBP,LDL-C,E2,EF values,P<0.05;2.In this study,carotid plaque was expressed by qualitative indicators,and 2 tests were used to obtain:Among 34 patients in the non-coronary heart disease group,fifteen(44.1%)detected carotid plaque;among 66 patients in the coronary artery disease group,fifty-three(80.3%)detected carotid plaque;among 29 patients in the CMVD group,seven(24.1%)detected carotid plaque2.1 Comparison between groups:2.1.1 The detection rate of carotid plaque in the coronary lesions group was significantly higher than that in the non-coronary lesions group,P<0.01.2.1.2 Comparison between CMVD group and non-coronary heart disease group:there was no statistical difference in the detection rate of carotid plaque between the two groups,P>0.05;among 29 patients in CMVD group,there were 22 patients without plaque,accounting for 75.9%;among 34 patients in non-coronary heart disease group,there were 19 patients without plaque,accounting for 55.9%;the detection rate of non plaque in CMVD group was significantly higher than that in non-coronary heart disease group,P<0.052.1.3 The detection rate of carotid plaque in coronary lesions group was significantly higher than that in CMVD group,P<0.013.20 indexes collected by three groups of patients were used as independent variables,and the degree of coronary lesions was an ordered dependent variable:There were statistical differences in 5 indexes,SBP,TCH,RDW,Hcy,EF,P<0.01.SBP,RDW,TCH and Hcy were the independent risk factors of coronary disease group and CMVD group,among which RDW and TCH were the most influential factors,positively correlated with the degree of coronary disease;EF was the related factor,negatively correlated with the degree of coronary disease.Conclusions:1.The female coronary heart disease is including coronary artery disease and microvascular lesions;2.The synergy of female coronary heart disease by a variety of related factors and influence.(1)Traditional risk factors:SBP,TCH;(2)New risk factors:RDW,Hcy;3.The main independent risk factors are SBP,TCH,RDW and Hcy.The most influential factors are TCH and RDW,which are positively correlated with the degree of coronary lesions.The larger the value is,the more serious the coronary lesions may be;4.Indirect predictorsCarotid intima thickness and carotid plaque can be used as indirect predictors to predict coronary heart disease.The thicker the carotid intima or the higher the detection rate of carotid plaque,the greater the possibility of coronary heart disease At the same time,carotid plaque can only reflect the presence of lesions in large coronary arteries,but not reflect the existence of microcirculation dysfunction in coronary arteries.