Seksen beş Yaş ve Üzerindeki Hastalarda Serum Lipidleri ile Koroner Arter Hastalığı Arasındaki İlişki

Yıl 2024, Cilt: 10 Sayı: 3, 550 - 557, 19.09.2024

Ali Osman Avcı

https://doi.org/10.53394/akd.1369114

Öz

Amaç: Bu çalışmanın amacı ülkemizdeki 85 yaş ve üstü hastalarda serum düşük dansiteli lipoprotein kolesterol (LDL-K) seviyesi ile koroner arter hastalığı (KAH) arasındaki ilişkiyi araştırmaktır.
Gereç ve Yöntem: Bu çalışma retrospektif olarak Ocak 2020-Temmuz 2023 tarihleri arasında hastaneye kabul edilen 85 yaş ve üzerinde olanların hasta dosyaları taranarak yapılmıştır. KAH tanısı konulan hastalar ile KAH tanısı olmayan hastaların serum lipid profilleri incelenmiştir. Hastaların serum lipid konsantrasyonları Cobas 501 ile ölçüldü. İstatiksel analiz SPSS ile yapıldı. Normal dağılım için değişkenler Kolmogorov Smirnov testi ile test edildi. Karşılaştırmalar için Mann-Whitney U testi kullanıldı. p<0.05 değeri istatistiksel olarak anlamlı kabul edildi.
Bulgular: Çalışmaya toplam 726 hasta alınmış olup bunların 433'ü kadın (% 59,6) 293'ü erkek (% 40,4) hastalardan oluşmaktadır. Hastalar LDL-K seviyesine göre üç gruba ayrıldı. Toplam 726 hastanın 277'sinde (% 38,2) KAH saptanmıştır. KAH olanların 142'si kadın (% 51,3), 135'i erkek (% 48,7) hastadır.
Sonuç: KAH, serum lipid düzeylerinden bağımsız olarak yaşla birlikte artmaktadır. İleri yaşta KAH sıklığı açısından kadın-erkek oranı yaklaşık olarak eşit hale gelmektedir. Serum lipid seviyeleri ve özellikle LDL-K ile KAH hastalığı arasında istatistiksel olarak anlamlı bir ilişki olmadığı görülmüştür.

Anahtar Kelimeler

85 yaş ve üzeri, koronrer arter hastalığı, LDL, HDL, TK, TG

The Relationship Between Serum Lipids and Coronary Artery Disease in Patients Aged 85 and Over

Öz

Objective: The aim of this study is to investigate the relationship between serum low-density lipoprotein cholesterol (LDL-C) level and coronary artery disease (CAD) in patients aged 85 and over in our country.

Material and Methods: This study was conducted retrospectively by scanning the patient files of those aged 85 and over who were admitted to the hospital between January 2020 and July 2023. Serum lipid profiles of patients diagnosed with CAD and patients without CAD were examined. Serum lipid concentrations of the patients were measured with Cobas 501. Statistical analysis was done with SPSS. Variables were tested for normal distribution with the Kolmogorov Smirnov test. Mann-Whitney U test was used for comparisons. A value of p<0.05 was considered statistically significant.

Results: A total of 726 patients were included in the study, 433 of whom were female (59.6%) and 293 were male (40.4%). Patients were divided into three groups according to LDL-C level. CAD was detected in 277 of 726 patients (38.2%). Of those with CAD, 142 are female (51.3%) and 135 are male (48.7%).

Conclusion: CAD increases with age, independent of serum lipid levels. In terms of CAD frequency, the ratio between men and women becomes approximately equal in older ages. It was observed that there was no statistically significant relationship between serum lipid levels, especially LDL-C, and CAD disease.

Anahtar Kelimeler

85 years and above, coronary artery disease, LDL, HDL, TC, TG

Kaynakça

• 1. Khan MA, Hashim MJ, Mustafa H, Baniyas MY, Al Suwaidi SKBM, AlKatheeri R, Alblooshi FMK, Almatrooshi MEAH, Alzaabi MEH, Al Darmaki RS, Lootah SNAH. Global Epidemiology of Ischemic Heart Disease: Results from the Global Burden of Disease Study. Cureus 2020; 12(7):e9349.
• 2. Onat A, Can G. Erişkinlerimizde Kalp Hastalıkları Prevalansı, Yeni Koroner Olaylar ve Kalpten Ölüm Sıklığı. A. Onat. TEKHARF 2017 Tıp Dünyasının Kronik Hastalıklara Yaklaşımına Öncülük. 2017; 20-29.
• 3. Falk E. Pathogenesis of Atherosclerosis. J Am Coll Cardiol 2006; 47(8 Suppl):C7-12.
• 4. Kagan A, Dawber TR, Kannel WB, Revotskie N. The Framingham Study: A Prospective Study of Coronary Heart Disease. Fed Proc 1962; 21(4)Pt 2:52-7.
• 5. Ference BA, Ginsberg HN, Graham I, Ray KK, Packard CJ, Bruckert E, Hegele RA, Krauss RM, Raal FJ, Schunkert H, Watts GF, Borén J, Fazio S, Horton JD, Masana L, Nicholls SJ, Nordestgaard BG, van de Sluis B, Taskinen MR, Tokgözoglu L, Landmesser U, Laufs U, Wiklund O, Stock JK, Chapman MJ, Catapano AL. Low-density lipoproteins cause atherosclerotic cardiovascular disease. 1. Evidence From Genetic, Epidemiologic, and Clinical Studies. A Consensus Statement From the European Atherosclerosis Society Consensus Panel. Eur Heart J 2017; 38(32):2459-72.
• 6. Baigent C, Keech A, Kearney PM, Blackwell L, Buck G, Pollicino C, Kirby A, Sourjina T, Peto R, Collins R, Simes R. Cholesterol Treatment Trialists' (CTT) Collaborators. Efficacy and Safety of Cholesterol-Lowering Treatment: Prospective Meta-Analysis of Data From 90,056 Participants in 14 Randomised Trials of Statins. Lancet 2005; 366(9493):1267-78.
• 7. Cholesterol Treatment Trialists’ (CTT) Collaboration; Baigent C, Blackwell L, Emberson J, Holland LE, Reith C, Bhala N, Peto R, Barnes EH, Keech A, Simes J, Collins R. Efficacy and Safety of More Intensive Lowering of LDL Cholesterol: A Meta-Analysis of Data From 170,000 Participants in 26 Randomised Trials. Lancet. 2010; 376(9753):1670-81.
• 8. Baigent C, Landray MJ, Reith C, Emberson J, Wheeler DC, Tomson C, Wanner C, Krane V, Cass A, Craig J, Neal B, Jiang L, Hooi LS, Levin A, Agodoa L, Gaziano M, Kasiske B, Walker R, Massy ZA, Feldt-Rasmussen B, Krairittichai U, Ophascharoensuk V, Fellström B, Holdaas H, Tesar V, Wiecek A, Grobbee D, de Zeeuw D, Grönhagen-Riska C, Dasgupta T, Lewis D, Herrington W, Mafham M, Majoni W, Wallendszus K, Grimm R, Pedersen T, Tobert J, Armitage J, Baxter A, Bray C, Chen Y, Chen Z, Hill M, Knott C, Parish S, Simpson D, Sleight P, Young A, Collins R; SHARP Investigators. The Effects of Lowering LDL Cholesterol with Simvastatin Plus Ezetimibe in Patients with Chronic Kidney Disease (Study of Heart and Renal Protection): A Randomised Placebo-Controlled Trial. Lancet 2011; 377(9784):2181-92.
• 9. Sabatine MS, Giugliano RP, Keech AC, Honarpour N, Wiviott SD, Murphy SA, Kuder JF, Wang H, Liu T, Wasserman SM, Sever PS, Pedersen TR; FOURIER Steering Committee and Investigators. Evolocumab and Clinical Outcomes in Patients with Cardiovascular Disease. N Engl J Med 2017; 376(18):1713-22.
• 10. Schwartz GG, Steg PG, Szarek M, Bhatt DL, Bittner VA, Diaz R, Edelberg JM, Goodman SG, Hanotin C, Harrington RA, Jukema JW, Lecorps G, Mahaffey KW, Moryusef A, Pordy R, Quintero K, Roe MT, Sasiela WJ, Tamby JF, Tricoci P, White HD, Zeiher AM; ODYSSEY OUTCOMES Committees and Investigators. Alirocumab and Cardiovascular Outcomes after Acute Coronary Syndrome. N Engl J Med 2018; 379(22):2097-2107.
• 11. Brown MS, Goldstein JL. A Receptor-Mediated Pathway for Cholesterol Homeostasis. Science 1986; 232(4746):34-47.
• 12. Glueck CJ, Kelley W, Gupta A, Fontaine RN, Wang P, Gartside PS. Prospective 10-Year Evaluation of Hypobetalipoproteinemia in A Cohort of 772 Firefighters and Cross-Sectional Evaluation of Hypocholesterolemia in 1,479 Men in the National Health and Nutrition Examination Survey I. Metabolism 1997; 46(6):625-33.
• 13. Cohen JC, Boerwinkle E, Mosley TH Jr, Hobbs HH. Sequence variations in PCSK9, low LDL, and Protection Against Coronary Heart Disease. N Engl J Med 2006; 354(12):1264-72.
• 14. Mach F, Baigent C, Catapano AL, Koskinas KC, Casula M, Badimon L, Chapman MJ, De Backer GG, Delgado V, Ference BA, Graham IM, Halliday A, Landmesser U, Mihaylova B, Pedersen TR, Riccardi G, Richter DJ, Sabatine MS, Taskinen MR, Tokgozoglu L, Wiklund O; ESC Scientific Document Group. 2019 ESC/EAS Guidelines For The Management of Dyslipidaemias: Lipid Modification To Reduce Cardiovascular Risk. Eur Heart J 2020; 41(1):111-88.
• 15. Mc Auley MT, Wilkinson DJ, Jones JJ, Kirkwood TB. A Whole-Body Mathematical Model of Cholesterol Metabolism and its Age-Associated Dysregulation. BMC Syst Biol 2012; 6:130.
• 16. Jacobs JM, Cohen A, Ein-Mor E, Stessman J. Cholesterol, statins, and Longevity From Age 70 to 90 Years. J Am Med Dir Assoc 2013; 14(12):883-8.
• 17. Liu HH, Zhang M, Chen RZ, Zhou JY, Qian J, Dou KF, Yan HB, Li JJ. Low-Density Lipoprotein Cholesterol in Oldest Old with Acute Myocardial İnfarction: Is Lower The Better? Age Ageing 2022; 51(9):afac202.
• 18. Lv Y, Mao C, Yin Z, Li F, Wu X, Shi X. Healthy Ageing and Biomarkers Cohort Study (HABCS): A Cohort Profile. BMJ Open 2019; 9(10):e026513
• 19. Lv YB, Yin ZX, Chei CL, Qian HZ, Kraus VB, Zhang J, Brasher MS, Shi XM, Matchar DB, Zeng Y. Low-Density Lipoprotein Cholesterol Was İnversely Associated with 3-Year All-Cause Mortality Among Chinese Oldest Old: Data From the Chinese Longitudinal Healthy Longevity Survey. Atherosclerosis 2015; 239(1):137-42.
• 20. Ravnskov U, Diamond DM, Hama R, Hamazaki T, Hammarskjöld B, Hynes N, Kendrick M, Langsjoen PH, Malhotra A, Mascitelli L, McCully KS, Ogushi Y, Okuyama H, Rosch PJ, Schersten T, Sultan S, Sundberg R. Lack of An Association Or An İnverse Association Between Low-Density-Lipoprotein Cholesterol and Mortality in The Elderly: A Systematic Review. BMJ Open 2016; 6(6):e010401.
• 21. Bathum L, Depont Christensen R, Engers Pedersen L, Lyngsie Pedersen P, Larsen J, Nexøe J. Association of Lipoprotein Levels With Mortality in Subjects Aged 50 + Without Previous Diabetes or Cardiovascular Disease: A Population-Based Register Study. Scand J Prim Health Care 2013; 31(3):172-80.
• 22. Postmus I, Deelen J, Sedaghat S, Trompet S, de Craen AJ, Heijmans BT, Franco OH, Hofman A, Dehghan A, Slagboom PE, Westendorp RG, Jukema JW. LDL Cholesterol Still A Problem in Old Age? A Mendelian Randomization Study. Int J Epidemiol 2015; 44(2):604-12.
• 23. de Ruijter W, Westendorp RG, Assendelft WJ, den Elzen WP, de Craen AJ, le Cessie S, Gussekloo J. Use of Framingham Risk Score and New Biomarkers to Predict Cardiovascular Mortality in Older People: Population Based Observational Cohort Study. BMJ 2009; 338:a3083.