Conventional risk factors among newly diagnosed coronary heart disease patients in Delhi

AIM:To analyze the conventional risk factors among newly diagnosed cases of coronary heart disease(CHD) admitted to a hospital in Delhi,India.METHODS:This hospital-based prospective study in-cluded 276 consecutive newly diagnosed cases of CHD in the Coronary Care Unit of a tertiary care hospital in Delhi.RESULTS:The mean age of the cases was 49.7± 9.5 years,with the youngest case aged 27 years.The two risk factors present most frequently among the cases were inadequate physical activity and abnormal lipid profile.Just about 3.6%of cases in our study had a physical activity level(PAL)that could be termed as"active",with a large proportion(96.4%)having a PAL suggestive of a sedentary lifestyle.A majority of patients were found to be current tobacco smokers(53.3%)and 188(68.1%)subjects were lifetime ever smokers.There was not a single case who did not have one or more of the risk factors.More than one-quarter(n=76)had six or more of the studied risk factors.CONCLUSION:Indians have among the CHD highest mortality rates amongst all ethnic groups studied so far.It is important to study the regional epidemiology of the cardiovascular events to allow for location-specific prevention and control programs.

Effect of Different Styles of Coronary Heart Disease and Its Risk Factors on Cardiac Remodeling and Dysfunction

Objectives To evaluate the effect of different styles of coronary heart disease （CHD）, different regions of acute myocardial infarction （AMI）, its risk factors and branches of coronary stenosis on left ventricular remodeling and dysfunction by applying echocardiography. Methods 251 patients with CHD and 96 patients without CHD （NoCHD） were verified by selective coronary angiography. CHD patients were divided into stable angina pectoris （SAP） 26, unstable angina pectoris（UAP） 53, acute myocardial infarction （AMI） 140 and old myocardial infarction （OMI） 30 based on clinical situation, cTnT, cardiac enzyme and ECG. AMI patients were further divided into subgroups including acute anterior myocardial infarct （Aa,n = 53）, acute inferior myocardial infarction （Ai, n=54） and Aa＋Ai （n=33） based on ECG. Cardiac parameters： end-diastolic interventricular septum thickness（IVSd）, end-diastolic left ventricular internal diameter （LVd）, left ventricular mass （LM）, end-diastolic left ventricular volume （EDV）, end-systolic left ventricular volume （ESV） and left ventricular ejection fraction（LVEF） were measured by ACUSON 128XP/10 echocardiography. Multiples linear regression analyses were performed to test statistical associations between LVEF and the involved branches of coronary stenosis, blood pressure, lipids, glucose and etc after onset of myocardial infarction. Results EDV and ESV were increased and LVEF decreased on patients with AMI,OMI and UAP （P〈0.05-0.0001）. LM was mainly increased in patients with OMI （P〈0.01） and LVd was mainly enlarged in patients with AMI. EF was significantly decreased and EDV, ESV, LM and LVd were remarkably increased in AMI patients with Aa and Aa＋Ai. With the multiple linear regression analyses by SPSS software, we found that LVEF was negatively correlated to the involved branches of coronary stenosis as well as to systolic blood pressure after onset of myocardial infarction while there was no significant correlation between LVEF and other factors. LVEF was significantly decreased, and LVd and LM increased in AMI patients with antecedent hypertension, compared to patients without hypertension （P〈0.001）. Conclusions Effects of different styles of CHD and different regions of AMI on left ventricular remodeling and cardiac function are different. Myocardial infarction, especially Aa and Aa＋Ai, is one of the most important causes of left ventricular remodeling and cardiac dysfunction. Multiple vessel stenosis and systolic blood pressure at the onset of myocardial infarction reduce LVEF in AMI patients. Antecedent hypertension may accelerate the effect of AMI on cardiac remodeling and dysfunction. Therefore primary and secondary preventions of CHD are critical for protecting heart from remodeling and dysfunction.

Risk factors for intracerebral hemorrhage and coronary heart diseases over a 3-year period in patients admitted to some hospitals of Tongliao city of Nei Monggol Autonomous Region Retrospective analysis on case data

BACKGROUND： Intracerebral hemorrhage（ICH） and coronary heart disease （CHD） have the same pathological base, atherosclerosis, and the similar risk factors,such as smoking ,drinking, hypertension, hyperlipemia, diabetes mellitus, etc; but the distributions of two diseases are very different in the populations. This may be related to the exposure of risk factors and different effects of risk factors on two diseases. OBJECTIVE： To analyze the distribution difference of risk factors for ICH and CHD in the populations of Tongliao city of Nei Monggol Autonomous Region. DESIGN： Retrospective analysis. SETTING： School of Radiation Medicine and Public Health, Soochow University; Tongliao Hospital, Nei Monggol Autonomous Region. PARTICIPANTS： Random sampling was used to select 6 hospitals from 10 hospitals affiliated to Tongliao City of Nei Monggol Autonomous Region. Totally 1 672 medical records of patients with ICH and 2 195 medical records of patients with CHD admitted to Department of Neurology and Department of Cardiovascular Internal Medicine of above-mentioned 6 hospitals between January 2003 and December 2005 were collected according to the investigation need. METHODS： The subjects, whose medical records were involved, were performed retrospective analysis with pre-prepared questionnaire ＂Stroke and Coronary Heart Disease Epidemiologic Questionnaire＂. The main contents included： ①Social demography condition： The distributions of gender, age, nationality, etc. ②Previous history of disease： hypertension, diabetes mellitus, etc. ③Related risk factors： systolic blood pressure, diastolic blood pressure, total cholesterol, triglyceride, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, smoking, drinking and glucose （GLU）. The database of Epidata was transformed to SPSS database. Single-and multiple-factor non-conditional Logistic regression analysis were performed on the data, and OR value and 95% CI were calculated. The distribution differences of risk factors for two diseases were compared. MAIN OUTCOME MEASURES： Single- and multi-factor non-conditional Logistic regression analysis results of each factor of patients. RESULTS： Single-factor non-conditional Logistic regression analysis showed that statistical significance existed in gender, age, nationality, smoking, drinking, history of hypertension, history of diabetes mellitus, hypertension, triglyceride （TG）, and GLU ten factors（OR =0.199, OR 95% CI 0.142-0.280 to OR =7.484, OR 95% CI 6.186-9.054, P 〈 0.01）. ②The results of multiple-factor non-conditional Logistic regression analysis showed 8 factors including age, gender, smoking, hypertension, history of hypertension, history of diabetes mellitus, GLU and TG（OR =0.203, OR 95% CI 0.114-0.361 to OR =8.262,OR 95% CI 5.466- 12.491, P 〈 0.01）. CONCLUSION： ICH and CHD are the diseases induced by various risk factors. Significant difference exists in gender, age, smoking, hypertension, history of hypertension, GLU, history of diabetes mellitus and TG.

Risk Factors and Intervention Status of Cardiovascular Disease in Elderly Patients with Coronary Heart Disease

To analyze the correlation between coronary heart disease and the possible risk factors such as age, gender, hypertension, dyslipidemia, smoking, diabetes, uric acid and plasma fibrinogen, to screen the main risk factors of coronary heart disease in the elderly and evaluate the intervention status of coronary heart disease in the elderly. In the unchangeable risk factors, age is still the main risk factor of coronary heart disease;in terms of gender, the onset age of female coronary heart disease is later than that of male, but the complications and mortality rate are higher than that of male, and the risk factors are more than that of male. The first level prevention needs doctors and patients to establish a mutual trust relationship, and actively intervene to reduce the total risk of cardiovascular disease. Drug compliance management should be strengthened in secondary prevention.

Depression risk in patients with coronary heart disease in Germany

AIM To determine the prevalence of depression and its risk factors among patients with coronary heart disease(CHD) treated in German primary care practices.METHODS Longitudinal data from nationwide general practices in Germany(n = 1072) were analyzed.Individuals initially diagnosed with CHD(2009-2013) were identified,and 59992 patients were included and matched(1:1) to 59992 controls.The primary outcome measure was an initial diagnosis of depression within five years after the index date among patients with and without CHD.Cox proportional hazards models were used to adjust for confounders.RESULTS Mean age was equal to 68.0 years(SD = 11.3).A total of 55.9% of patients were men.After a five-year follow-up,21.8% of the CHD group and 14.2% of the control group were diagnosed with depression(P < 0.001).In the multivariate regression model,CHD was a strong risk factor for developing depression(HR =1.54,95%CI:1.49-1.59,P < 0.001).Prior depressive episodes,dementia,and eight other chronic conditions were associated with a higher risk of developing depression.Interestingly,older patients and women were also more likely to be diagnosed with depression compared with younger patients and men,respectively.CONCLUSION The risk of depression is significantly increased among patients with CHD compared with patients without CHD treated in primary care practices in Germany.CHD patients should be routinely screened for depression to ensure improved treatment and management.

Periodontal disease is associated with increased coronary heart disease risk:A meta-analysis based on 38 case-control studies

AIM: To investigate whether periodontal disease(PD) is associated with increasing coronary heart disease(CHD) risk by performing a meta-analysis.METHODS: Two authors independently searched Pub Med and China National Knowledge Infrastructure up to January 10 th, 2013 for relevant case-control studies that investigated the association between PD and CHD. After quality assessment using Newcastle-Ottawa Scale and data extraction by two independent authors, the overall and subgroup meta-analyses were performed and publication bias were examined using the Comprehensive Meta-Analysis V2 software. Potential publication bias was assessed using visual inspection of the funnel plots, Egger linear regression test, and trims and fill method.RESULTS: Finally 38 relevant case-control studies were identified, involving 4950 CHD patients and 5490 controls. Eleven studies were rated low quality and 27 were high quality. Based on random-effects, a significant association was identified between PD and CHD(OR 3.79, 95%CI: 2.23-6.43, P < 0.001, I2 = 98.59%), and sensitivity analysis showed that this result was robust. Subgroup analyses according to adjusted/unadjusted ORs, source of control, methodological quality, end point, assessment of PD/CHD, and ethnicity also indicated a significant association. Publication bias was detected, and the estimated OR including the "missing" studies did not substantially differ from our estimate with adjustment for missing studies(OR 4.15, 95%CI: 2.62-6.54, P < 0.001).CONCLUSION: Based on the meta-analysis, PD is probably associated with CHD risk independently and significantly.

Interleukin-18, matrix metalloproteinase-22 and -29 are independent risk factors of human coronary heart disease

Background： Coronary heart disease （CHD） is characterized by arterial wall inflammation and matrixdegradation. Matrix metalloproteinase （MMP）-22 and -29 and pro-inflammatory cytokine interleukin-18 （IL18） arepresent in human hearts. IL18 may regulate MMP-22 and -29 expression, which may correlate with CHD progression.Methods and results： Immunoblot analysis showed that ILl8 induced MMP-22 expression in human aortic smoothmuscle cells. The Mann Whitney test from a prospective study of 194 CHD patients and 68 non-CHD controlsdemonstrated higher plasma levels of IL18, MMP-22 and-29 in CHD patients than in the controls. A logistic regressiontest suggested that plasma IL18 （odds ratio （OR）=1.131, P=0.007）, MMP-22 （OR=1.213, P=0.040）, and MMP-29（OR=1.198, P=0.033） were independent risk factors of CHD. Pearson＇s correlation test showed that IL18 （coefficient（r）=0.214, P=0.045; r=0.246, P=0.031） and MMP-22 （t=0.273, P=0.006; r=0.286, P=0.012） were associated with theGensini score before and after adjusting for potential confounding factors. The multivariate Pearson＇s correlation testshowed that plasma MMP-22 levels correlated positively with high-sensitive-C-reactive protein （hs-CRP） （r=0.167,P=0.023）, and MMP-29 levels correlated negatively with triglyceride （t=-0.169, ,P=-0.018）. Spearman＇s correlation testindicated that plasma IL18 levels associated positively with plasma MMP-22 （t=0.845, P〈0.001） and MMP-29 （r=0.548P〈0.001）. Conclusions： Our observations suggest that IL18, MMP-22 and -29 serve as biomarkers and independentrisk factors of CHD. Increased systemic IL18 in CHD patients may contribute to elevated plasma MMP-22 and -29levels in these patients.

Characteristic analysis of clinical coronary heart disease and coronary artery disease concerning young and middle-aged male patients

BACKGROUND Coronary heart disease(CHD)is a type of coronary atherosclerotic heart disease.In recent years,the incidence of CHD has been increasing annually,with an increasing number of young patients.Severe CHD may cause severe myocardial ischemia or myocardial necrosis,which in turn may cause myocardial infarction and related complications that seriously affect the life and health of the patient.AIM To examine the coronary arteries and clinical features of young and middle-aged male patients with CHD.METHODS From February 2019 to January 2020,110 male CHD patients admitted to our hospital were selected as research subjects and were divided into two groups by age:middle-aged group(n=55)and young group(n=55).The coronary arteries and clinical features of the patients were compared.RESULTS There were no significant differences in dyslipidemia,stroke history,high-density lipoprotein cholesterol,or triacylglycerol(P>0.05)between the two groups.In the young group,age,diabetes,hypertension,smoking history,body mass index,family history of CHD,drinking history,fibrinogen,low-density lipoprotein cholesterol,total cholesterol,and single-vessel disease were higher than those in the middle-aged group.Correspondingly,serum uric acid,hyperuricemia,myocardial infarction,Gensini score>50,collateral circulation,multivessel disease,double vessel disease,involvement of the right coronary artery,and involvement of the left main coronary artery were lower in the young group than in the middle-aged group.The middle-aged group mainly suffered from a high Gensini score,implicating multiple arteries,whereas the young group was mainly affected by single-vessel disease.The between-group difference was significant(P<0.05).CONCLUSION In CHD attacks,multiple coronary arteries are implicated in middle-aged male patients and single-vessel disease in young male patients.

The Case-Control Study Between DDAH2 Polymorphism and Coronary Heart Disease

Background and Aim Asymmetric dimethylarginine(ADMA),an endogenous inhibitor of nitric oxide synthase(NOS),has been shown to be an independent predictor of coronary heart disease(CHD).Dimethylarginine dimethylaminohydrolase-2(DDAH2) promotes the metabolism of ADMA and plays a key role in formation of the atherosclerosis.We hypothesized that genetic variation inDDAH2 gene might alter the susceptibility to CHD.Methods We tested our hypothesis in a case-control studies.We used ahaplotype-tagging single nucleotide polymorphisms(SNP) approach to identify tag SNP in DDAH2.The SNP were genotyped by poly-merase chain reaction-restriction fragment length polymorphism(PCR-RFLP) and ligase detection reaction(LDR)-sequencing in 1650patients with CHD and 1920 control subjects.Results Apromoter variant-449C/G(rs805305) and -1415G/A(rs2272592)in DDAH2 was identified in the region containing DDAH2.The frequency of those polymorphism were consistent with the lawof Har-dy-Weinberg.The frequency of rs805305 CG +GG or G allele was not significantly different between CHD and wild-type genotype(OR: 0.667,95%CI: 0.374 to 1.187,P>0.05).The frequency of rs2272592 GA +AA or A allele also showed no significant difference between CHD and wild-type genotype(OR: 1.420,95%CI: 0.899 to 2.242,P>0.05).No association was observed be-tween the DDAH2 variant and CHD.These results was independent of age,gender,hypertension,diabetes and hyperlipidemia.Conclusions Our results suggest that although DDAH2/ADMA pathway acts as a critical regulator of coronary atherosclerotic heartdisease,the DDAH2 common variant may not predict the susceptibility to CHD in Chinese population.

The Study on the Correlation Between Plasma Adiponectin Level and Coronary Heart Disease

Objectives To investigate the relationship between plasma adiponectin level and coronary heart disease （CHD）, and some established cardiovascular risk factors and to probe its probable pathogenesis which adiponectin results in CHD. Methods The levels of plasma adiponectin, fasting plasma insulin （FINS）, C-reactive protein （CRP） and P-selectin were measured by ELISA, plasma ET-1 was measured by radioimmunoassay （RIA） in 75 male patients with CHD and 30 healthy male people. Body mass index （BMI）, waist / hip ratio （WHR） and insulin resistance index （Homa-IR） were calculated respectively. Results （1）The plasma adiponectin levels in CHD group were lower compared with control group[（5.18±2.57）mg / L vs（8.94±2.59）mg / L, P〈 0.001 ], there was no significant difference of plasma adiponectin levels in CHD sub-groups （P 〉 0.05）.（2） Based on multinominal stepwise logistic regression analysis, adiponectin was one of significant and independent risk factors for CHD. （3） Multivariate liner stepwise regression analysis showed that adiponectin had significant correlation with BMI and TG, BMI and TG were independent factors influencing on plasma adiponectin levels. （4） Pearson correlation analysis indicated plasma adiponectin levels were inversely related to FINS levels , Homa-IR, CRP, P-selectin and ET-1. Conclusions （ 1 ）Plasma adiponectin levels are lower in CHD patients compared the control subjects, there are no significant difference of plasma adiponectin levels in patients with SAP, UAP and AMI. （2） Plasma adiponectin levels are relative with CHD. Hypoadiponectinemia is an independent risk factor for CHD. （3）Established cardiovascular risk factors such as BMI and TG have an obvious influence on adiponectin. （4）The probable pathogenesis by which adiponectin involves in CHD is suggested that adiponectin relates to insulin resistance, inflammatory reaction and dysfunction of vessel endothelium.

Coronary heart disease： incidence, risk factors and interventions in Jiaozhou of Shandong province

Background Coronary heart disease （CHD） is the most common type of heart disease and cause of heart attacks.This study investigated the epidemiological characteristics of CHD and its risk factors in Jiaozhou,Shandong province,to ultimately find a way of reducing the prevalence of cardiovascular disease,and to provide a theoretical basis for establishing a cardiovascular disease management path under the regional medical collaborative mechanism.Methods A questionnaire survey was performed including 1 952 people aged 35 years or older who were questioned by means of stratified,cluster,proportional sampling to investigate the prevalence of CHD and its risk factors.The data were inputted into SPSS11.0 statistical software for processing and analysis.We advised the local medical institutions to establish health files for the residents with CHD and risk factors.They were followed up regularly.Their risk factors and life-style were monitored,and advice was given as to proper medications.Green channels were established,and the patients were transmitted in a timely manner to superior hospitals for better treatment if the necessary treatments were not available in the local hospitals.The control of risk factors was observed after the follow-up for half a year.Results In Jiaozhou,the rates of coronary artery disease,hypertension,diabetes,hyperlipidemia and overweight were 8.15％,28.54％,11.43％,35.46％,and 18.70％ respectively.The rates of hypertension,diabetes,hyperlipidemia and overweight were higher than the data published in ＂The report of Chinese cardiovascular disease 2012＂; which are 24％,9.7％,18.6％,and 9.7％,respectively.The control of risk factors improved significantly after the guidance of the residents lifestyle and medication for six months.Conclusions The high prevalence of coronary artery disease in Jiaozhou is closely related to age,gender,diet structure,family history of cardiovascular disease,hypertension,diabetes,hyperlipidemia,overweight,and unhealthy lifestyle.Under the regional medical coordination mechanism,the collaborative management of cardiovascular disease can provide new management concepts for the areas short of medical resources,so as to reduce the prevalence of cardiovascular disease.

Coronary heart disease-related fatigue:risk factors,assessment and treatments

Coronary atherosclerotic heart disease is a disease of myocardial ischemia and hypoxia,which often presents as chest pain,dyspnea,cold sweat and fatigue.Fatigue is the subjective experience of patients,which is easy to be ignored,and will lead to the decline of patients’quality of life and physical activity level,etc.,with a high incidence and great harm.The purpose of this paper was to review the concept,risk factors,assessment tools and intervention measures of coronary atherosclerotic heart disease fatigue in order to provide a reference for identifying and improving the fatigue of coronary atherosclerotic heart disease.

Factors Influencing the Diferent Incidences between Coronary Heart Disease and Stroke

To search factors influencing morbidity between coronary heart disease(CHD) and stroke, a longitudinal prospective study was done in a cohort of 1 809 participants aged 3574 at entry of Jiangsu province, China. The average annual agedadjusted incidence of stroke was 142.3/\{100 000\}, being over 1315 years more than that of coronary event(CE)(49.1/100 000), the difference of the incidences between the two diseases was very significant(P<0.01). Multivariate regression analysis revealed that the main risk factors of CHD include increase of serum total cholecsterol, hypertension and mental stress, whereas the most important risk factors for stroke consist of elevation of systolic blood pressure(SBP) as well as smoking and alcohol drinking habit. It was noted that these participants in cohort usually had high salt intake, low animal protein diet, and low level of serum cholecsterol with high level of blood presure and smoking and alcohol habit. We suggest that rational dietary food, stopping smoking, limited alcohol and community control of hypertension are the preventive strategy against these diseases.

Risk factors in cardiovascular patients:Challenges and opportunities to improve secondary prevention

BACKGROUND Effective management of major cardiovascular risk factors is of great importance to reduce mortality from cardiovascular disease(CVD).The Survey of Risk Factors in Coronary Heart Disease(SURF CHD)II study is a clinical audit of the recording and management of CHD risk factors.It was developed in collaboration with the European Association of Preventive Cardiology and the European Society of Cardiology(ESC).Previous studies have shown that control of major cardiovascular risk factors in patients with established atherosclerotic CVD is generally inadequate.Azerbaijan is a country in the South Caucasus,a region at a very high risk for CVD.AIM To assess adherence to ESC recommendations for secondary prevention of CVD based on the measurement of both modifiable major risk factors and their therapeutic management in patients with confirmed CHD at different hospitals in Baku(Azerbaijan).METHODS Six tertiary health care centers participated in the SURF CHD II study between 2019 and 2021.Information on demographics,risk factors,physical and laboratory data,and medications was collected using a standard questionnaire in consecutive patients aged≥18 years with established CHD during outpatient visits.Data from 687 patients(mean age 59.6±9.58 years;24.9%female)were included in the study.RESULTS Only 15.1%of participants were involved in cardiac rehabilitation programs.The rate of uncontrolled risk factors was high:Systolic blood pressure(BP)(SBP)(54.6%),low-density lipoprotein cholesterol(LDL-C)(86.8%),diabetes mellitus(DM)(60.6%),as well as overweight(66.6%)and obesity(25%).In addition,significant differences in the prevalence and control of some risk factors[smoking,body mass index(BMI),waist circumference,blood glucose(BG),and SBP]between female and male participants were found.The cardiovascular health index score(CHIS)was calculated from the six risk factors:Non-or ex-smoker,BMI<25 kg/m2,moderate/vigorous physical activity,controlled BP(<140/90 mmHg;140/80 mmHg for patients with DM),controlled LDL-C(<70 mg/dL),and controlled BG(glycohemoglobin<7%or BG<126 mg/dL).Good,intermediate,and poor categories of CHIS were identified in 6%,58.3%,and 35.7%of patients,respectively(without statistical differences between female and male patients).CONCLUSION Implementation of the current ESC recommendations for CHD secondary prevention and,in particular,the control rate of BP,are insufficient.Given the fact that patients with different comorbid pathologies are at a very high risk,this is of great importance in the management of such patients.This should be taken into account by healthcare organizers when planning secondary prevention activities and public health protection measures,especially in the regions at a high risk for CVD.A wide range of educational products based on the Clinical Practice Guidelines should be used to improve the adherence of healthcare professionals and patients to the management of CVD risk factors.

Profile and Correlates of Health-related Quality of Life in Chinese Patients with Coronary Heart Disease

Background： Although coronary heart disease （CHD） is one of the major cardiovascular diseases, risk factors associated with the health-related quality of life （HRQoL） of CHD patients remain unclear. The present study was designed to determine the profile and significant factors of the HRQoL in CHD patients.Methods： A cross-sectional study was conducted in rural communities of Fangshan District, Beijing. China. Socio-demographic, lifestyle, and comorbidity information of CHD patients were collected by a structured questionnaire and medical records. HRQoL was measured using European Quality of Life 5-dimensions （EQ-5D） scale and EQ Visual Analog Scale （EQ-VAS）. Multiple linear and logistic regressions were performed to explore the association of potential risk factors with HRQoL scores and each EQ-SD, respectively.Results： Totally, 1928 CHD patients （mean age 61.64 ± 9.24 years; female：male = 2.4：1） were enrolled in the study. The mean score of EQ-5D index and EQ-VAS were 0.889 ±0.172 and 71.56 ±17.65, respectively. Multiple linear regression revealed that marital status, physical activity, moderate alcohol drinking, and family＇s population were positive independent correlates of EQ-VAS, whereas diabetes mellitus and stroke were negative independent correlates （all P 〈 0.05）. Age and stroke were negatively while physical activity, moderate alcohol drinking, family＇s population and household income were positively correlated with EQ-5D index （all P 〈 0.05） independently. In addition, each of the five HRQoL dimensions had various specific determinants, including obesity, underweight. smoking or education. Conclusions： Findings of the study highlight certain socio-demographic, lifestyle factors, and comorbid stroke or diabetes mellitus as correlates of HRQoL in Chinese CHD patients. Large-scale cohort studies should be carried out to confirm our results in the future.

Nonalcoholic fatty liver disease is a novel predictor of cardiovascular disease

AIM:To clarify whether nonalcoholic fatty liver disease(NAFLD)increases the risk of cardiovascular disease.METHODS:We carried out a prospective observational study with a total of 1637 apparently healthy Japanese men and women who were recruited from a health check-up program.NAFLD was diagnosed by abdominal ultrasonography.The metabolic syndrome(MS)was defined according to the modified National Cholesterol Education Program(NCEP)ATP Ⅲ criteria.Five years after the baseline evaluations,the incidence of cardiovascular disease was assessed by a self-administered questionnaire.RESULTS:Among 1221 participants available for outcome analyses,the incidence of cardiovascular disease was higher in 231 subjects with NAFLD at baseline(5 coronary heart disease,6 ischemic stroke,and 1 cerebral hemorrhage)than 990 subjects without NAFLD(3 coronary heart disease,6 ischemic stroke,and 1 cerebral hemorrhage).Multivariate analyses indicated that NAFLD was a predictor of cardiovascular disease independent of conventional risk factors(odds ratio 4.12,95% CI,1.58 to 10.75,P = 0.004).MS was alsoindependently associated with cardiovascular events.But simultaneous inclusion of NAFLD and MS in a multivariate model revealed that NAFLD but not MS retained a statistically significant correlation with cardiovascular disease.CONCLUSION:Although both of them were predictors of cardiovascular disease,NAFLD but not MS retained a statistically significant correlation with cardiovascular disease in a multivariate model.NAFLD is a strong predictor of cardiovascular disease and may play a central role in the cardiovascular risk of MS.

冠心病PCI术后合并睡眠障碍患者氧化应激水平的变化及其危险因素分析

目的探究因冠心病(CHD)行经皮冠状动脉介入治疗(PCI)术后并发睡眠障碍患者的氧化应激水平的变化及其危险因素。方法回顾性分析2018年6月至2023年6月期间于攀枝花市第三人民医院心内科就诊并行PCI术的128例CHD患者临床资料,采用匹兹堡睡眠质量指数量表(PSQI)评估PCI术后是否并发睡眠障碍,并依据评分结果将患者分为并发组(n=35)和未并发组(n=93)。对比分析两组血清中超氧化物歧化酶和丙二醛的表达水平,采用单因素分析对患者基本资料(性别、年龄、体重指数、腰臀比、文化程度、是否吸烟或饮酒等)和生理病理情况[合并疾病、焦虑、术后疼痛、术后用药情况、每周运动时间、纽约心脏病协会(NYHA)心功能分级、植入支架数]进行分析,采用多因素Logistic回归分析对影响CHD患者行PCI术后并发睡眠障碍的因素进行分析。结果并发组患者血清超氧化物歧化酶水平为(61.68±10.32)U/mL,低于未并发组[(78.11±15.38)U/mL],并发组丙二醛水平为(2.72±0.44)μmol/L,高于未并发组[(2.02±0.38)μmol/L],差异均有统计学意义(P<0.05)。单因素分析结果显示,年龄、腰臀比、合并高脂血症、焦虑、术后疼痛和每周运动时间是CHD患者行PCI术后并发睡眠障碍的影响因素。多因素Logistic回归分析结果显示,超氧化物歧化酶(OR=1.290,95%CI:1.145~1.454)、丙二醛(OR=1.667,95%CI:1.362~2.040)、年龄(OR=1.672,95%CI:1.348~2.074)、腰臀比(OR=1.368,95%CI:0.901~2.076)、焦虑(OR=1.470,95%CI:1.021~2.116)、术后疼痛(OR=1.844,95%CI:1.175~2.894)和每周运动时间(OR=1.261,95%CI:0.911~1.746)为影响CHD患者行PCI术后并发睡眠障碍的独立危险因素。结论CHD行PCI术后并发睡眠障碍的患者氧化应激水平显著高于未并发睡眠障碍患者;超氧化物歧化酶、丙二醛、年龄、腰臀比、焦虑、术后疼痛和每周运动时间为影响CHD患者行PCI术后并发睡眠障碍的独立危险因素。

老年高血压患者合并冠心病的危险因素分析

目的本研究旨在分析老年高血压患者合并冠心病的危险因素。方法纳入2019年1月至2023年1月济南市妇幼保健院全科门诊收治的老年高血压患者228例为研究对象,根据冠状动脉造影显示是否合并冠心病分为冠心病组(125例)和非冠心病组(103例)。冠心病组男64例,女61例,年龄67~80(75.16±1.38)岁;非冠心病组男52例,女51例,年龄60~71(64.53±1.26)岁。收集所有患者的一般资料,通过Gensini评分评估患者的冠脉病变程度;并对患者进行全天血压监测,通过舒张压和收缩压计算全天血压负荷值,通过心脏磁共振(CMR)评估心肌灌注储备(MPR);测定患者血小板参数、血脂四项、纤维蛋白原、血浆比黏度等血液流变学指标。通过超声检查比较两组患者的斑块检出率、斑块指数和冠状动脉钙化积分(CACS)。比较两组患者各项指标的差异,通过多因素logistic回归分析探讨老年高血压患者合并冠心病的危险因素,并通过Pearson相关系数分析各项指标和Gensini评分的相关性。使用独立样本t检验、χ^(2)检验。结果共纳入228例高血压患者,其中合并冠心病125例,其Gensini评分显著高于非冠心病组[(96.21±10.25)分比(21.03±3.36)分](P<0.05);多因素logistic回归分析结果显示,年龄、血压负荷情况、MPR、平均血小板体积、血液流变学指标、斑块指数、CACS均是老年高血压患者合并冠心病的影响因素(均P<0.05);Gensini评分与血压负荷情况、血浆比黏度、斑块指数和CACS均呈正相关,与MPR呈负相关(均P<0.05)。结论年龄、血压负荷情况、MPR、血小板参数、血液流变学指标、斑块指数、CACS均是老年高血压患者合并冠心病的影响因素。

冠心病患者冠脉介入治疗术后预后不良的列线图预测模型构建

目的分析冠心病患者经冠脉介入术治疗预后不良的相关因素,构建列线图预测模型并评价其性能。方法纳入2020年9月至2022年8月滕州市中医医院收治的冠心病患者300例作为研究对象,所有患者行冠脉介入术治疗,根据术后1年随访是否发生心血管不良事件分为观察组(n=61)和对照组(n=239)。对两组的临床资料进行统计分析,通过受试者工作特征(ROC)曲线分析有统计学意义的连续性变量;采用多元Logistic回归分析冠心病患者冠脉介入治疗术后预后不良的独立危险因素;R软件构建预测冠心病患者术后预后不良的列线图模型;校正曲线对预测模型进行内部验证;决策曲线评估预测模型的临床净收益。结果观察组糖尿病比例、吸烟比例、植入支架数>2比例、D-二聚体和白介素-6水平高于对照组(均P<0.05),D-二聚体(>1.23 mg/L)、白介素-6(>50.01 ng/L)、年龄(>66岁)、合并糖尿病和吸烟是冠心病患者冠脉介入治疗术后预后不良的独立危险因素(P<0.05)。内部验证结果显示,列线图预测模型的C-index为0.786(95%CI:0.397,0.896),观测值与预测值之间保持较好一致性。决策曲线显示当风险阈值>0.16时,此预测模型可以提供额外的临床净收益。结论本研究构建了冠心病患者冠脉介入治疗术后预后不良危险因素的列线图预测模型,有助于医护人员认识冠心病患者术后预后不良的相关因素,尽早制定个性化对策以改善预后,提升患者生活质量。

冠心病合并糖尿病患者经皮冠状动脉介入术后支架内再狭窄危险因素的研究进展

冠心病(冠状动脉粥样硬化性心脏病)合并糖尿病患者冠状动脉支架内再狭窄率显著高于未合并糖尿病患者。其特征以糖代谢异常、血糖波动、胰岛素抵抗为核心,且往往伴发高脂血症、高尿酸血症、凝血及纤维蛋白溶解指标异常、慢性炎症等,这些因素直接或间接影响了血管内皮功能,促使平滑肌增生、凝血异常等,并最终导致再狭窄的发生。本综述主要针对糖尿病合并冠心病患者经皮冠状动脉介入术后支架内再狭窄危险因素的研究进行总结探讨,以期为临床降低支架内再狭窄发生率及预防不良心血管事件的发生提供参考依据。