The Research Of Cardiovascular Risk Factors, The Severity Of Coronary Artery Lesions And One-year Follow-up Of Medication Adherence After Percutaneous Coronary Intervention In Female Patients With Coronary Artery Disease

BackgroundIn many countries,the morbidity and mortality rate of CAD are the highest.As profound understanding for the pathogenesis,risk factors of CAD and improved control means for CAD,the morbidity and mortality rate of CAD show a downward trend year by year.However,this trend seems to be imbalance between men and women,the downward trend in women is less obvious than in men,so there are probably obvious gender differences for CAD.Compared with men,there exists worse prognosis of CAD,greater probability recurrence of the myocardial infarction, higher risk of death in women.In recent years,the female CAD has aroused widespread concern in the medical field.The latest statistics of American College of Cardiology(ACC) in 2004 showed that CAD had became the first disease which leads to death and disability in female,the first women's "killer" in developed countries and regions,so it is necessary to get a comprehensive understanding of cardiovascular risk factors in female and to adopt a correct assessment and treatment without delay.Clinical trials have demonstrated the efficacy of aspirin,β-blockers(BBs), angiotensin-converting enzyme inhibitors / angiotensin receptor blocker(ACEI/ARB), and statins medications for secondary prevention of CAD.The ACC/AHA clinical practice guidelines recommendations these medications for patients with CAD to reduce recurrent cardiovascular events.However,prior studies have shown medication nonadherence is a common problem among outpatients with CAD, limiting the effectiveness of secondary prevention medications.And little is known about the impact of nonadherence on outcomes of patients who undergone PCI procedure.ObjectivesThis research was specifically designed to study the characteristic of cardiovascular risk factors in female patients with CAD though contrasting female patients with male patients,to assess characteristics of drug compliance in female patients with CAD after PCI,and to explore the impact of drug compliance on clinical prognosis.We also intented to explore the cardiovascular risk factors, coronary artery lesion characteristics and their relationship in female patients with CAD by contrast between female patients with CAD and female patients without CAD.Methods1.Study populationThis study population included hospitalized patients with percutaneous coronary intervention(PCI) in the cardiology department of NanFang Hospital,Zhujiang Hospital,wich affiliated Southern Medical University,and the cardiology department of Zhongshan City People's Hospital of Zhongshan Medical University from January 2007 to December 2007 in part one of study.In part two of study,the study population included hospitalized female patients with coronary angiography in the cardiology department of NanFang Hospital of Southern Medical University from January 2005 to December 2005.The inclusive and exclusive criteria were adopted for study population in this study.2.Research Methods2.1 Risk factorsThe risk factors in this study included age,hypertension,type 2 diabetes, dyslipidemia,family history of premature CAD,high uric acid levels,low hemoglobin levels,high plasma fibrinogen and serum total bilirubin.The dyslipidemia includes total cholesterol(TC),low-density lipoprotein cholesterol (LDL-C),the high-density lipoprotein cholesterol(HDL-C),the lower triglyceride (TG)2.2 Coronary angiographyThe professional medical doctor from the cardiology department finished the coronary angiography by means of conventional femoral artery or the radial artery. The coronary artery disease was defined as coronary artery lesions involving the main coronary artery,stenosis≥50%.The degree of coronary artery lesions was measured by means of Gensini score.2.3 Follow-upThe content and follow-up manner according to AHA / ACC and other coronary heart disease secondary prevention guidelines updated version of 2006,select Aspirin, BBs,ACEI / ARB and Statins,such as the four categories of drugs to study the drug. Patients discharged from the hospital medical record medication acquisition, post-discharge follow-up information obtained through follow-up for the telephone or out-patient follow-up,follow-up include:the medication after discharge,such as patients stop taking the drug,then asked in detail about the timing and reasons for discontinuation.The definition of compliance for the follow-up period and discharge patients taking the same drugs(the same type of combination of drugs),at the same time we also evaluate the patients according to this definition of various types of drug compliance.2.4 Study End PointThe composite end point was the occurrence of major adverse cardiac events (MACE) and ST at 1 year after the procedure;MACE was defined as a composite of cardiac death,non-fatal myocardial infarction(MI),and target vessel revascularization(TVR).3.Statistical MethodsThe SPSS statistical package for Windows version 13.0 was used for the statistical analysis.Continuous variables were expressed as mean value±standard deviation((?)±s),and the comparison between groups was made using 2 independent-samples t test;Categorical variables were expressed by percentage(%), the chi-square test was used to compared categorical variables;The Logistic(forward method) regression was used in multivariate analysis.The P value＜0.05 was considered statistically significant.Results1.Part one of study1.1 Enrollment and Baseline characteristicsThe study population included hospitalized patients with PCI in the cardiology department of NanFang Hospital,Zhujiang Hospital,which affiliated Southern Medical University,and the cardiology department of Zhongshan City People's Hospital of Zhongshan Medical University from January 2007 to December 2007.In this study,624 cases were finally selected,and 78 cases were excluded,among 78 cases,3 cases were with cardiac shock,2 cases with severe renal insufficiency,and 4 patients with MACE in hospitalization.59 cases were lost to follow-up during 1 year. In this Study population,altogether 628 cases were for the risk factors study,624 cases for follow-up study.1.2 Risk factors characteristics1.2.1 Age factor:a preliminary statistical analysis of coronary angiography confirmed 628 cases of patients with CAD,including 175 cases of female patients with CAD and 453 cases of male patients with CAD,the statistical analysis results also showed that female group with CAD(age 65.95±9.30) were older than male group(age 60.63±11.52),P＜0.001.After younger cases of 55 years age were excluded,the number of female patients group with CAD was 153 cases,male patients group with CAD 297 cases.1.2.2 Single factor analysis result:compared with male patients with CAD,the proportion of many factors in female patients were significantly elevated,such as hypertension,diabetes,high density lipoprotein cholesterol,triglyceride levels and plasma fibrinogen levels,but there were not significantly different for low-density lipoprotein cholesterol,total cholesterol,serum total bilirubin between female patients and male patients.1.3 Follow-up outcomes1.3.1 Drug complicance:At discharge,aspirin was prescribed in 90.8%,BBs in 52.0%,ACEI/ARB in 60.7%,and statins in 93.6%among female patients with CAD. During 1-year follow-up,the proportion of female patients with CAD,who adherent to aspirin,BBs,ACEI/ARB and statins,was respectively 82.7%,46.2%,45.1%,and 74.6%.Drug compliance of female patients with CAD in four types was respectively 91.1%,88.9%,73.6%and 79.6%,so adherence was the lowest for ACEI/ARB and highest for aspirin.Drug compliance of male patients with CAD in four types was respectively 93.5%,89.1%,81.7%and 83.8%.Compared with male patients with CAD,drug compliance of male patients with CAD in four types was similar,and the difference between them was not statistically significant.1.3.2 Characteristics of combined with drugs use:At discharge,the proportion of female patients with CAD who use of 1-,2-,3-,and 4-type of drugs was 0.6%,18.5%,53.2%和27.7%,respectively.During 1-year follow-up,the proportion of female patients with CAD who continued use of 1-,2-,3-,and 4-type of drugs was 9.8%,29.5%,39.3%和19.1%,respectively.During 1-year follow-up,the proportion of female patients with CAD taking four types of drugs was similar to that at discharge,the proportion of four types of drugs significantly reduced,but increased for the proportion of one and two types of drugs.Compared with male patients,the proportion of female patients with CAD taking three types of drugs was higher,but lower for the proportion of four types of drugs.The proportion of female patients with CAD taking one and two types of drugs was similar to male patients.1.3.3 The occurrence of cases of MACE:The outcome of 1-year follow-up study indicated that accumulated incidence of non-fatal MI and TVR in female patients with CAD group was significantly higher than in male patients with CAD group.The drug compliance rate,cardiac death,and MACE were not significantly different between two study groups.2.Part two of study2.1 Enrollment and Baseline characteristicsThe study population included hospitalized female patients with coronary angiography in the cardiology department of NanFang Hospital affiliated Southern Medical University from January 2005 to December 2007.Altogether 235 cases were collected by inclusion and exclusion criteria.There were 171 cases of female patients with CAD,84 cases of female with non-CAD among 235 cases.Baseline characteristics:patients with high blood pressure134 cases(57.02%),type 2 diabetes 63 cases(26.81%),high LDL-C 60 cases(25.53%),low HDL-C 65 cases(27.66%), high TG 84 cases(35.74%),high TC 114 cases(48.51%).2.2 Coronary angiography resultsAltogether 76 cases of famale(32.3%) patients were diagnosed without coronary lesions by means of coronary angiography,and 159 cases of female patients(67.7%) were diagnosed with CAD.among them,84 cases(35.7%) with one branch lesion,49 cases(20.7%) with two branch lesions,26 cases(11.1%) with three branch lesions. Total Gensini score ranged from 0 to175 points,total Gensini score were compared among the 4 groups,the Group one for 0,the Group two for 0＜score≤20,the Group three for 20＜score≤47,the Group four for 47＜score≤175.2.3 Risk factors characteristicsUnivariate analysis result:among all groups with different extent and severity of CAD,with the number of diseased vessels and the Gensini scores increasing,the percentage of cases with each risk factor(hypertension,type 2 diabetes,high triglycerides,high total cholesterol,low HDL-C,high LDL-C,high uric acid disease, high fibrinogen) increased.Multivariate analysis result:Logistic regression analysis showed that high low-density lipoprotein was the most significant independent risk factor in female patients with CAD,and other risk factors ranked:diabetes,triglycerides,high uric acid,low high-density lipoprotein,high blood pressure,and age.Conclusion1.There exist multiple risk factors in female patients with CAD,including high LDL-C,diabetes,hypertension,triglycerides,age,high uric acid level,but high LDL-C are the most significant independent risk factors and high uric acid are the most significant new risk factors in female patients with coronary heart disease.2.The percentage of hypertension and diabetes in female patients with CAD was significantly higher than those in the male patients with CAD,and the triglyceride level in female patients with CAD was significantly higher than those in the male patients with CAD too.3.The medication compliance are similar between the female patients with CAD and male patients,they are both poor compliance for the drug ACEI / ARB.4.Compared with male patients with CAD,the female patients are with higher incidence of non-fatal myocardial infraction and target-vessel revascularization, worse prognosis after PCI.