Analysis Of The Risk Factors And Clinical Characteristics In Premenopausal Women With Coronary Heart Disease

BackgroundIn the recent years, with the development of country’s economy and the change of people’s life style, the incidence of cardiovascular disease, especially coronary heart atherosclerotic disease (CHD) has been rising of year by year and getting increasingly younger. CHD has become one of the most common diseases to jeopardize people’s health and threaten people’s life. It was thought that the incidence of CHD was lower in premenopausal women, because of the protective effects of estrogen, and was increased when women experienced menopause. However, recent studies have shown that the incidence of coronary heart disease was significantly increased in younger women, especially for premenopausal women. Nowadays, there are insufficient attention, diagnosis and treatment to women with coronary heart disease, who often have a poor clinical outcome. Rare reports relating to the study of coronary heart disease in premenopausal women can be found in both domestic and overseas. The study was to analyze the risk factors and clinical characteristics in premenopausal women with coronary heart disease.ObjectiveTo explore risk factors and clinical characteristics of CHD in premenopausal women, raise people’s awareness of CHD in premenopausal women, provide certain theoretical basis for the prevention and treatment of coronary heart disease.Methods116 premenopausal women patients diagnosed as CHD were included, and all cases were in accordance with the criterion between January 2013 and December 2014 in the First Affiliated Hospital of Xinxiang Medical College. According to the coronary angiography results, all patients were divided into CHD group(A group, n=56) and non-CHD group (B group, n=60), collect all the cases of general clinical data, including age, smoking history, hypertension history, diabetes history and family history of coronary heart disease. The level of triglyceride(TG), total cholesterol(TC), high density lipoprotein cholesterol(HDL-C), low density lipoprotein cholesterol(LDL-C),blood uric acid(UA), homocysteine(HCY) were detected in all the cases. Meanwhile we detected the content of the high sensitive C-reactive protein(hs-CRP), immunoglobulin IgG, immunoglobulin IgA, immunoglobulin IgM, Complement 3(C3), Complement 4(C4) and estrodiol(E2) in all the cases. Moreover,70 cases of male(C group, n=70) with CHD, who was confirmed by the CAG, were selected as a gender control group. Analyzing the angiographic feature in premenopausal women with CHD. The severity of coronary artery stenosis is evaluated by the Gensini score. Analyzing clinical characteristics of premenopausal women with CHD. All the patients were informed and signed the informed consent, and approved by our hospital’s ethics committee in advance.ResultsCompared with the non-CHD group in premenopausal women, the proportion of diabetes, hypertension and the level of TG, LDL-C, HCY was significantly higher in the group with CHD(P<0.05), on the other hand,the level of HDL-C and E2 was prominently lower in the group with CHD(P<0.05), there was neither any conspicuous differences in the age of two group(P>0.05). Multi-factor Logistic regression analysis showed that diabetes, hypertension, TG, LDL-C, HCY were independent risk factors for CHD group patients, E2 and HDL-C were protective factors for CHD group patients(P<0.05). Compared with the non-CHD group in premenopausal women, there were markedly higher level of IgG, IgA, IgM, C3, C4(P<0.05). Correlation analysis showed that the hs-CRP level of CHD group in premenopausal were positively related to the the level of IgG, IgA, IgM, C3, C4.Compared with the male group, there were notably higher proportion of one-vessle lesion and lower proportion of double-vessle lesion(P<0.05). In the multi-vessel lesions, there was no statistical differences between the group of premenopausal women and the group of male with CHD(P>0.05); The proportion of left anterior descending (LAD) lesion in the group of premenopausal women was strikingly higher than in the male group with CHD(P<0.05). Among the left circumflex artery(LCX), right coronary artery(RCA) and left main(LM), there were no statistical differences between the male group and the group of premenopausal women with CHD(P>0.05).There was signally higher proportion of Gensini score of group a and b, lower proportion of Gensini score of group d and e in the group of premenopausal women than in the the male group with CHD(P<0.05). There was no statistical differences in proportion of Gensini score of group c between the two group(P>0.05).The percentage of patients with stable angina pectoris(S AP) was observably higher in the group of premenopausal women with CHD than in the male group(P<0.05). The percentage of patients with myocardial infarction(MI) was markedly lower in the group of premenopausal women with CHD than in the male group (P<0.05). As the percentage of unstable angina(UAP), there was no statistical differences between the two group(P> 0.05).Conclusions1. Diabetes, hypertension, TG, LDL-C, HCY are independent risk factors for premenopausal women with CHD, E2 and HDL-C are protective factors for premenopausal women with CHD. Hyperthyroidism of humoral immune function is exist in premenopausal women with CHD. Hs-CRP has synergy effect with IgG, IgA, IgM, C3, C4. The pathogenesis of inflammation and humoral immune may participant the occurrence and development of the CHD in premenopausal women.2. The clinical symptom is atypical in premenopausal women with CHD. The incidence of single vessel disease is remarkablely high and the LAD is involved most easily in the premenopausal women with CHD, the degree of the coronary lesion, which are mostly nonobstructive lesions, is not heavy. And the stable angina is the mainly type of coronary heart disease in premenopausal women.