| Background and purposeCoronary Heart Disease(CHD)is a heart disease with coronary atherosclerosis as the main pathological change.The stenosis or occlusion of the coronary lumen leads to myocardial ischemia,hypoxia,and the imbalance of oxygen consumption and oxygen supply to the myocardium,resulting in a series of serious cardiovascular events such as angina pectoris and myocardial infarction.The casualties caused by coronary heart disease have raised heavy burdens to families and society.With the development of clinical medicine,the overall mortality rate of coronary heart disease has decreased,but this trend is different in the sexes.It means that the mortality rate of coronary heart disease in men is decreased significantly,but in women it is raised steadily.As a research shows,the incidence of coronary heart disease in women has surpassed that in men and become the leading threat to women's health in China and the United States.Compared with men,women have specific risk factors in coronary heart disease,mainly because of the changes in hormone levels during reproductive aging.A large number of domestic and international studies have demonstrated that during the the perimenopausal phase,the ovarian function begins to decline,the level of serum cholesterol increases,and lipid profile develops toward the direction of atherosclerosis.Thus increase the risk of cardiovascular disease.Therefore,the evaluation and management of blood lipid level and degree of atherosclerosis in perimenopausal women should be strengthened.Traditional methods of atherosclerosis assessment include the blood lipid test,X-ray,ultrasound and angiography.Due to the invasiveness and other side-effects,X-ray and angiography are limited in the application of cardiovascular disease screening.And because of non-invasive,no radiation,easy to operation and other advantages,the blood lipid measurement and ultrasound have been widely used in the clinical diagnosis.This study aims to explore the correlation between carotid artery Crouse score,AIP and the occurrence of coronary heart disease in perimenopausal women,and provide theoretical reference for the early prevention and treatment of coronary heart disease in perimenopausal women.MethodsFemale patients with suspected coronary heart disease admitted to the department of cardiology in the first Affiliated Hospital of Zhengzhou University from January 2015 to January 2018 were selected.All patients had taken blood biochemical examination,cervical vascular ultrasound and coronary angiography.By analyzing the menstrual and reproductive history,a total of 388 perimenopausal patients,aged between 40 and 55 years,were included.According to the results of coronary angiography,the included subjects were divided into CHD group(n=201)and non-CHD group(control group,n=187).To analyze the differences between the two groups in clinical index such as age,smoking,alcohol consumption,history of diabetes,history of hypertension,family history of early coronary heart disease,platelet volume,platelet distribution width,uric acid,total cholesterol,triglyceride,high density lipoprotein,low density lipoprotein,plasma atherosclerosis index(AIP),and carotid Crouse score.The incidence of coronary heart disease was compared according to the AIP quartile level.Take the AIP and Crouse score as target indexes,and explore the correlation between other indexes and AIP-Crouse score.Relatively independent Logistic regression analysis models were established based on the correlation results.For each model,the occurrence of coronary heart disease was taken as the dependent variable,and the general medical history data,blood biochemical test and cervical vascular ultrasound index were taken as the independent variables for Logistic regression analysis.According to the results of regression analysis,We identified the significant risk factors for coronary heart disease in perimenopausal women,and then analyzed these risk factors under the ROC curve and compared the area under the curve to evaluate the predictive power of risk factors.Results1.Compared with the control group,the proportion of perimenopausal women with coronary heart disease combined with diabetes or hypertension,the level of PDW,uric acid,TG,AIP and Crouse score were increased,and the level of HDL-C were decreased,the difference was statistically significant(P<0.05).There was no significant difference in the remaining indicators(P>0.05).2.The subjects were divided into 4 groups according to the AIP quartile.The results showed that with the increase of AIP level,the incidence of coronary heart disease in perimenopausal women was raised continuously,and the difference between the four groups was statistically significant(df=3,?2=58.747,P<0.001).Compared between two groups,the results showed that there were significant statistical differences in the incidence of coronary heart disease in perimenopausal women between A1 and A3,A1 and A4,A2 and A4,A3 and A4(P<0.0083).Especially when AIP>0.2834,the incidence of coronary heart disease increased significantly.There were no statistically significant differences between A1 and A2,A2 and A3(P>0.0083).3.Logistic regression analysis of single independent variable of CHD showed that diabetes,hypertension,uric acid,TG,AIP and Crouse score were the risk factors for the occurrence of coronary heart disease in perimenopausal women,and HDL-C was the protective factor(P<0.05).4.The correlation analysis showed that AIP was strongly correlated with HDL-C(r=-0.736,P<0.001)and TG(r=0.946,P<0.001).Therefore,in order to avoid the interaction of strong correlation indicators,the indicators with strong correlation were analyzed separately and two independent logistic regression models were established.The dependent variable was whether coronary heart disease occurred(value:1 for coronary heart disease and 0 for non-coronary heart disease).AIP,diabetes,hypertension,uric acid and Crouse score were independent variables to constitute model 1.TG,HDL-C,diabetes,hypertension,uric acid and Crouse score were independent variables to constitute model 2.The combined results of the two models suggested that diabetes,hypertension,AIP,Crouse score and TG were significan risk factors for coronary heart disease in perimenopausal women.5.The results of ROC curve analysis showed that the area under curve(95%CI)of Crouse score,TG,AIP and AIP combined Crouse score were 0.672(0.618?0.725),0.690(0.638?0.742),0.711(0.660?0.762),and 0.760(0.712?0.808).The predictive power of CHD in perimenopausal women was in the order:AIP combined with Crouse score>AIP>Crouse score.There was no significant statistical difference between the Crouse score and TG(P=0.6097),and the predictive value of Crouse score for CHD was no less than TG.The combined index had better predictive value than the single index,and was the strongest predictor of CHD in perimenopausal women.6.When AIP was 0.13,the predictive value of perimenopausal CHD was the highest,and the specificity and sensitivity were 77.54%and 59.20%.After combined with Crouse score,the sensitivity was improved greatly(68.16%)under the condition that the specificity(75.94%)was basically unchanged.Conclusion1.AIP is positively correlated with CHD in perimenopausal women.2.AIP,Crouse score and TG are important risk factors for CHD in perimenopausal women except hypertension and diabetes.3.AIP combined with Crouse score has a better prediction ability than single index.Through simple data conversion and plaque score,the early assessment of perimenopausal women with CHD can be made,so that the diagnosis and treatment of CHD in women can move forward. |
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