Relationship between cardiovascular risk factors and coronary artery disease severity assessed by coronary angiography in Turkish patients

Yıl 2020, Cilt: 4 Sayı: 12, 1143 - 1146, 01.12.2020

Şeyda Günay , Seçkin Dereli , Osman Akın Serdar , Güven Özkaya , Serhat Çalışkan

https://doi.org/10.28982/josam.743746

Öz

Aim: Established coronary risk factors are good predictors of the occurrence of coronary artery disease (CAD), but their correlation with angiographic seriousness of the disease is argumentative and may vary among ethnic groups. In this study, we examined which of these factors are associated with the angiographic seriousness in Turkish patients with attested CAD.
Methods: A total of 2433 patients who underwent coronary angiography and were diagnosed with critical lesions in at least one coronary artery were included in the study. Coronary risk factors were determined by retrospectively scanning the patient records and the relationship with the angiographic severity of coronary artery disease was investigated.
Results: Most patients (36.4%) were between 60-69 years of age and approximately two thirds of patients (76.8%) were men. Hypertension, diabetes mellitus and hyperlipidemia were common cardiovascular risk factors (CRFs), present in 54.8%, 43.2% and 50.3% of patients, respectively. Multiple logistic regression analysis showed that diabetes mellitus, male sex and age since 6th decade significantly raised the risk of multivessel CAD (Odds ratios: 1.29 (1.08-1.54; P=0.004), 1.35 (1.1-1.66; P=0.004), 3.53 (1.85-6.75; P<0.001), respectively). Hypertension and hyperlipidemia were not correlated with CAD angiographic severity.
Conclusion: Diabetes mellitus appeared as the modifiable coronary risk factor forecasting multivessel coronary artery disease in Turkish patients.

Anahtar Kelimeler

Turkish, ethnic, angiography, risk, multi vesseL

Koroner anjiyografi ile değerlendirilmiş Türk hastalarda kardiyovasküler risk faktörleri ve koroner arter hastalığı ciddiyeti arasındaki ilişki

Öz

Amaç: Koroner arter hastalığı risk faktörleri, koroner arter hastalığının (KAH) ortaya çıkışının iyi öngördürücülerdir, ancak bunların hastalığın anjiyografik ciddiyeti ile korelasyonları tartışmalıdır ve etnik gruplar arasında farklılık gösterebilir. Bu çalışmada, kanıtlanmış KAH olan Türk hastalarda kardiyovasküler risk faktörlerinin hastalığın anjiyografik ciddiyeti ile ilişkisi araştırıldı.
Yöntemler: Koroner anjiyografi ile değerlendirilerek en az bir koroner arterde kritik lezyon saptanan 2433 hasta çalışmaya dahil edildi. Hasta kayıtları retrospektif taranarak hastaların koroner risk faktörleri tespit edildi ve koroner arter hastalığının anjiyografik ciddiyeti ile ilişkisi araştıırldı.
Bulgular: Çalışma popülasyonunda hastaların çoğu (%36,4) 60-69 yaşları arasındaydı ve hastaların yaklaşık üçte ikisi (%76,8) erkekti. Hipertansiyon, diyabetes mellitus ve hiperlipidemi hastaların sırasıyla% 54,8,%43,2 ve %50,3'ünde mevcuttu. Çoklu lojistik regresyon analizinde, diabetes mellitus, erkek cinsiyet ve 6. dekattan itibaren yaşın, çok damarlı KAH riskini önemli ölçüde artırdığı saptandı (odds oranları sırasıyla 1,29 (1,08-1,54; P=0,004), 1,35 (1,1-1,66; P=0,004), 3,53 (1,85-6,75; P<0,001). Hipertansiyon ve hiperlipidemi, KAH’ın anjiyografik ciddiyeti ile ilişkili değildi.
Sonuç: Türk hastalarda çok-damar koroner arter hastalığını ön gördüren düzeltilebilir koroner arter hastalığı risk faktörü diyabetes mellitustur.

Anahtar Kelimeler

Türk, Etnik, Anjiyografi, Risk, Çoklu damar

Kaynakça

• 1. D'Agostino RB Sr, Vasan RS, Pencina MJ, Wolf PA, Cobain M, Massaro JM, et al. General cardiovascular risk profile for use in primary care: the Framingham Heart Study. Circulation. 2008 Feb 12;117(6):743-53. doi: 10.1161/CIRCULATIONAHA.107.699579. Epub 2008 Jan 22. PMID: 18212285.
• 2. Murray CJ, Lopez AD. Evidence-based health policy--lessons from the Global Burden of Disease Study. Science. 1996 Nov 1;274(5288):740-3. doi: 10.1126/science.274.5288.740. PMID: 8966556.
• 3. Yusuf S, Hawken S, Ounpuu S, Dans T, Avezum A, Lanas F, et al. INTERHEART Study Investigators. Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): case-control study. Lancet. 2004 Sep 11-17;364(9438):937-52. doi: 10.1016/S0140-6736(04)17018-9. PMID: 15364185.
• 4. Banerjee A, Lim CC, Silver LE, Heneghan C, Welch SJ, Mehta Z,et al. Family history does notpredict angiographic localization or severity of coronary arterydisease. Atherosclerosis. 2012;221:451-7.
• 5. Guo YH, Zhang WJ, Zhou YJ, Zhao D, Zhou ZM, Zhang H. Study of the relationship between cardiovascular risk factors and severity of coronary artery disease in patients underwent coronary angiography.Zhonghua Xin Xue Guan Bing Za Zhi. 2005;33:415-8.
• 6. Hasin Y, Eisenberg S, Friedlander J, Lewis BS, Gotsman MS. Relationship between extent of coronary artery disease and correlative risk factors. Am Heart J. 1979 Nov;98(5):555-61. doi: 10.1016/0002-8703(79)90279-5. PMID: 227261.
• 7. Koliaki C, Sanidas E, Dalianis N, Panagiotakos D, Papadopoulos D, Votteas V, et al. Relationship between established cardiovascular risk factors and specific coronary angiographic findings in a large cohort of Greek catheterized patients. Angiology. 2011 Jan;62(1):74-80. doi: 10.1177/0003319710370960. Epub 2010 May 24. PMID: 20498145.
• 8. Krishnaswami S, Jose VJ, Joseph G. Lack of correlation between coronary risk factors and CAD severity. Int J Cardiol. 1994 Nov;47(1):37-43. doi: 10.1016/0167-5273(94)90131-7. PMID: 7868283.
• 9. Tacoy G, Balcioglu AS, Akinci S, Erdem G, Kocaman SA, Timurkaynak T, et al. Traditional risk factors are predictive on segmental localization of coronary artery disease. Angiology. 2008 Aug-Sep;59(4):402-7. doi: 10.1177/0003319708318379. Epub 2008 May 27. PMID: 18505741.
• 10. Wang XL, Tam C, McCredie RM, Wilcken DE. Determinants of severity of coronary artery disease in Australian men and women. Circulation. 1994 May;89(5):1974-81. doi: 10.1161/01.cir.89.5.1974. PMID: 8181120.
• 11. Chaturvedi N. Ethnic differences in cardiovascular disease. Heart. 2003 Jun;89(6):681-6. doi: 10.1136/heart.89.6.681. PMID: 12748237; PMCID: PMC1767706.
• 12. Harding S, Rosato M, Teyhan A. Trends for coronary heart disease and stroke mortality among migrants in England and Wales, 1979-2003: slow declines notable for some groups. Heart. 2008 Apr;94(4):463-70. doi: 10.1136/hrt.2007.122044. Epub 2007 Aug 9. PMID: 17690159; PMCID: PMC2565582.
• 13. Onat A. Risk factors and cardiovascular disease in Turkey. Atherosclerosis. 2001 May;156(1):1-10. doi: 10.1016/s0021-9150(01)00500-7. PMID: 11368991.
• 14. Kutlu R., Memetoğlu ME, Evaluation of cardiovascular risk factors among university students in Turkey: a cross-sectional survey. Russian Open Medical Journal. 2013;2:3-7.
• 15. Rosamond W, Flegal K, Furie K, Go A, Greenlund K, Haase N, et al. Heart disease and stroke statistics--2008 update: a report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Circulation. 2008 Jan 29;117(4):e25-146. doi: 10.1161/CIRCULATIONAHA.107.187998. Epub 2007 Dec 17. Erratum in: Circulation. 2010 Jul 6;122(1):e10. Kissela, Bret [corrected to Kissela, Brett]. PMID: 18086926.
• 16. Greenland P, Knoll MD, Stamler J, Neaton JD, Dyer AR, Garside DB, et al. Major risk factors as antecedents of fatal and nonfatal coronary heart disease events. JAMA. 2003 Aug 20;290(7):891-7. doi: 10.1001/jama.290.7.891. PMID: 12928465.
• 17. Phillips GB, Pinkernell BH, Jing TY. Are major risk factors for myocardial infarction the major predictors of degree of coronary artery disease in men? Metabolism. 2004 Mar;53(3):324-9. doi: 10.1016/j.metabol.2003.11.008. PMID: 15015144.
• 18. Vlietstra RE, Kronmal RA, Frye RL, Seth AK, Tristani FE, Killip T 3rd. Factors affecting the extent and severity of coronary artery disease in patients enrolled in the coronary artery surgery study. Arteriosclerosis. 1982 May-Jun;2(3):208-15. doi: 10.1161/01.atv.2.3.208. PMID: 6979996.
• 19. Anderson AJ, Barboriak JJ, Rimm AA. Risk factors and angiographically determined coronary occlusion. Am J Epidemiol. 1978 Jan;107(1):8-14. doi: 10.1093/oxfordjournals.aje.a112511. PMID: 623092.
• 20. Opherk D, Scola R, Morgenstern W, Stockmann G, Nüssel E, Kübler W. Beziehungen von "Risikofaktoren" der Arterioskelrose zum Schweregrad der angiographisch nachweisbaren Koronarsklerose [Coronary risk factors and extent of angiographically proven coronary artery stenoses (author's transl)]. Z Kardiol. 1979 Jun;68(6):369-74. German. PMID: 463194.
• 21. Veeranna V, Pradhan J, Niraj A, Fakhry H, Afonso L. Traditional cardiovascular risk factors and severity of angiographic coronary artery disease in the elderly. Prev Cardiol. 2010 Summer;13(3):135-40. doi: 10.1111/j.1751-7141.2009.00062.x. PMID: 20626669.
• 22. Alderman EL, Corley SD, Fisher LD, Chaitman BR, Faxon DP, Foster ED et al. Five-year angiographic follow-up of factors associated with progression of coronary artery disease in the Coronary Artery Surgery Study (CASS). CASS Participating Investigators and Staff. J Am Coll Cardiol. 1993 Oct;22(4):1141-54. doi: 10.1016/0735-1097(93)90429-5. PMID: 8409054.
• 23. Kirpichnikov D, Sowers JR. Diabetes mellitus and diabetes-associated vascular disease. Trends Endocrinol Metab. 2001 Jul;12(5):225-30. doi: 10.1016/s1043-2760(01)00391-5. PMID: 11397648.
• 24. Nurkalem Z, Hasdemir H, Ergelen M, Aksu H, Sahin I, Erer B, et al. The relationship between glucose tolerance and severity of coronary artery disease using the Gensini score. Angiology. 2010 Nov;61(8):751-5. doi: 10.1177/0003319710373747. Epub 2010 Jun 21. PMID: 20566575.
• 25. LaRosa JC, Brown CD. Cardiovascular risk factors in minorities. Am J Med. 2005 Dec;118(12):1314-22. doi: 10.1016/j.amjmed.2005.04.041. PMID: 16378771.
• 26. Hasan RK, Ginwala NT, Shah RY, Kumbhani DJ, Wilensky RL, Mehta NN. Quantitative angiography in South Asians reveals differences in vessel size and coronary artery disease severity compared to Caucasians. Am J Cardiovasc Dis. 2011;1(1):31-7. Epub 2011 Apr 20. PMID: 22254183; PMCID: PMC3253512.