The Relationship Between Distribution And Clustering Of Risk Factors For CHD And The Extent Of Coronary Artery Lesion And The Prediction Of CAOS

Objective1. To investigate the distribution characteristics of risk factors in different classic coronary artery disease, the relationship between the clustering of risk factors of coronary heart disease (CHD)and coronary artery lesions.2. To study whether clinical risk factors can predict coronary obstructive score, so that it can provide the evidence for clinical therapy.Methods:1. We selected 2285 case of receiving coronary angiography(CAG).Patients' Peripheral blood were tested by routine assay, including blood routine, blood clotting routine, fasting plasma glucose, and the echocardiography was taken, assembling related disease history, family history et al. To study the different distribution of risk factors between the patients with and without coronary heart disease and the difference of sub-coronary heart disease.we analyzed the relationship of the numbers of lesion vessels, the extent of lesion and risk factors, and Logistic regression was used to analyze the independent risk factors of CHD.2. We used the method that counted the number of risk factors to analyze the distribution of the number of risk factors presented in different gender and to assess the relationship between aggregating risk factors and the positive rate of CAG, the number of vessel disease, severity and extent of the coronary artery lesion (coronary artery obstructive score).3. We used multiple linear regression analysis to make a regression equation of the CAOS and the risk factors.Result1. Relationship of each risk factor to classic of CHD, coronary artery lesion1.1 Comparison of the basic data in different species of CHD and the extent of coronary lesion.1.11 Gender and CHDThe rate of male was higher in CHD than that in control group, in subgroup of CHD the rate of male was higher in ACS than in SAP(P=0.000). The more the number of lesion vessel, the extent of lesion, the higher rate of male. (P=0.000)1.1.2 Age and CHDThe average of age was older in CHD patients than that in control (P=0.000) and among the subgroups, SAP's age was older than ACS's (P<0.05). Age was gradually increased with increasing the numbers of diseased vessel and the severity of lesion.1.1.3 Smoking and CHDCompared with control, the positive rate of smoking was significantly higher in CHD patients (P=0.000). In subgroup of CHD, smoking's rate was higher in ACS than in SAP patients (P=0.000). DVD and the fifth group had a high positive rate of smoking.1.1.4 Family history and CHDIn ACS patients, the positive family history were a significant higher than that in SAP and control group (p=0.000). There was no statistical difference in the different numbers vessel disease (p=0.179). Compared with other three groups the positive of family history in second, fifh and sixth group were markedly increased (P=0.004).1.1.5 Stroke and CHDHistory of stroke was higher in CHD group than in control (P=0.000). SAP's was higher than ACS's in subgroups (P=0.000). The positive of stroke was increasing with the raise of the lesion-vessel's number and the severity of coronary artery stenosis.1.2 Hypertension and CHDThe positive of hypertension was significant higher in CHD than that in control group. Compared to ACS, the proportion of hypertension in SAP was higher. There was statistical significance (P=0.000). In the different extent of coronary artery lesion group, the more involving the lesion number and the severity of stenosis, the more positive of hypertension, in which the highest was forth group. SBP and PP level were higher in SAP, multi-lesion vessel and severity diseased group. DBP had no statistical significance in each group.1.3 Uric acid and CHDThe concentration of uric acid was higher in CHD patient than that in control's. (P=0.007). In the subgroup of CHD, no statistical difference was found. 1.4 DM and CHD The positive of DM in CHD was notable higher than in control's. In the subgroup, SAP was higer than ACS. The positive of DM was gradually increased with the number of lesion vessel and the extent of stenosis increasing. FPG and INS were marked increased in ACS group, and the level of FPG and INS were increased when the number vessel disease and the extent of artery lesion were increasing. FPG and INS in triple-vessel disease were significant higher than in single-vessel disease (P=0.000,0.000), and in fifth and sixth group were higher than in first and second group (P=0.000,0.000).1.5 Hyperlipemia and CHDTotal triglyceride and total cholesterol had no difference between CHD and control(PTG=0.937,0.252, PTC=0.638,0.825), and also in different subgroup of CHD (p>0.05). The level of total cholesterol of triple-vessel disease was markedly increased when compared to single-vessel disease and double-vessel disease. (P=0.006,0.049). Serum HDL-C level was lower and LDL-C was higher in CHD than in control group (P=0.000,0.000). With the number of vessel lesion and the extent of lesion increased, HDL-C showed a gradually decreasing tendency, while LDL-C increased(P<0.05).1.6 WBC, FIB and CHDWhen compared with control's, WBC is markedly increased in the CHD patients (P=0.000). WBC in ACS was higher than in SAP. The more number of vessel disease, the higher of WBC. Among them, the triple-vessel disease was highest. In the forth-sixth group, WBC was significant increased when compared with first-third groups (P<0.05)The concentration of FIB was higher in SAP group than in ACS and control (P=0.030). The levels of FIB in triple-vessel disease was highest among the different number of vessel disease groups(P=0.000,0.004).FIB in sixth group was significant higher than first group (P=0.017)1.7 Bilirubin and CHDThree categories of bilirubin (total bilirubin, indirect bilirubin, direct bilirubin) in CHD had no significant difference between CHD and control and in different group of CHD. 1.8 LVPW and CHDCompared with ACS and control, LVPW in SAP was significantly increased (p=0.000). There was no difference in the various number of vessel disease. LVPW in third and forth group was higher than that in first-second and fifth-sixth groups(P< 0.05).1.9 Correlation and logistic regression analysis between each risk factors of CHD and Coronary Artery Obstruct Score (Gensini score).CAOS had a positive correlation with age, smoking, hypertension, DM, FPG, INS, LDL-C, WBC and UA, and a negative correlation with female and HDL-C. Binary Logistic regression analysis showed that age, smoking, DM, LDL-C, WBC and FPG were independent risk factors for CHD. While female and HDL-C were independent protecting factors.2. The relationship between risk factors aggregation and the severity of coronary artery lesion and gender.The positive of CAG and CAOS were gradually increased with increasing the number of risk factors in individual. The percentage of male was increased with number of risk factors increasing and exceeding over the female's. After compared with hypertension(H), diabetes mellitus(D), hyperlipemia(X), smoking(S) and the different combination of these in the different gender, we found the proportion of male was higher than that in female in S, SH, SD, SX, SHD, SHX, SDX and lower in H, X, HD, HX,HDX (P<0.05). D, DX and SHDX had no statistical difference in male and in female. (p=0.164,0.068,0.055)3. Prediction of risk factors and coronary artery obstructive scoreUsing the Multiple linear regression analysis, we access the regression equation as follow:Ygensiniscore=-0.965EF+2.806FPG+12.809gender(male=l,female=0)+0.694 a-ge+6.117DM(yes=l,no=0)+1.744WBC-13.993HDL-C+3.429LDL-C+0.123INS. Multiple correlation coefficient R=0.553, coefficient of determination R2=0.306, F=58.99, P=0.000. The regression equation had a statistical significant.Conclusion1. CAOS had a positive correlation with age, smoking, hypertension, DM, FPG, INS, LDL-C, WBC, FIB and the number of risk factors, and had a negative correlation with female, HDL-C. Age, smoking, DM, LDL-C, WBC and FPG were independent risk factors and female HDL-C were independent protecting factors.2. The clustering of the CHD risk factors was associated with positive rate of coronary angiography and the extent and the severity of coronary artery lesions. The more the clustering of risk presented, the more severity of the CHD3. The proportion of male was higher than that of female in presenting more than two risk factors. The important influence on male was smoking, while on female was hypertension and hyperlipemia.4. The risk factors that had independent prediction for CAOS are EF, FPG, gender, age, DM, WBC, HDL-C, LDL-C and INS.