Radtke S, Wolf R
Abteilung Kardiologie/Rehabilitation Herz-Kreislauf-Klinik Bevensen AG Römstedter Str. 25 29549 Bad Bevensen, Germany.
Z Kardiol. 2001 May;90(5):352-8. doi: 10.1007/s003920170165.
The pathophysiology and prognosis of coronary heart disease in women are the subject of intensive epidemiological and clinical investigations due to sex specific considerations. We have estimated the prevalence of modifiable coronary risk factors in 36 consecutive women (mean age 59.7 years) with suspected coronary heart disease in whom coronary angiography was performed due to unclear chest pain. Seventeen women revealed angiographically normal coronary arteries (gr. I) and 19 women showed coronary vessels with initial arteriosclerosis (luminal diameter reduction < 35%) (gr. II). Mean age was 59.1 years in gr. I and 60.3 years in gr. II (p = ns). No woman received lipid lowering drugs within the last 6 months. A hormone replacement therapy was not performed in any case. Women in gr. I showed significantly higher total and LDL cholesterol levels (271.6 +/- 34.3 vs 243.5 +/- 44.8 mg/dl; p < 0.005 and 190.5 +/- 36.8 vs 149.7 +/- 45.1 mg/dl; p < 0.025, respectively) and significantly lower HDL cholesterol values (57.8 +/- 16.5 vs 72.8 +/- 19.1 mg/dl; p < 0.0125) compared to women in gr. II. The total/HDL cholesterol ratio was 3.6 +/- 1.2 in gr. I and 5.1 +/- 1.7 in gr. II (p < 0.005). The positive predictive value for the existence of initial coronary atherosclerosis and a total cholesterol/HDL ratio > 4 was 76.5%. The negative predictive value and a ratio < 4 was 81.3%. Women in gr. I revealed 1.2 +/- 0.9 and in gr. II 1.6 +/- 0.8 risk factors (smoking, hypertension, body mass index > 30 kg/m2, diabetes mellitus, hyperlipidemia) (p < 0.10). The 10-year risk for the occurrence of a coronary event was 9.1 +/- 3.7% in gr. I and 14.2 +/- 5.8% in gr. II (p < 0.005). The positive predictive value for the existence of initial coronary atherosclerosis and a 10-year risk > 10% was 90%. The negative predictive value and a 10-year risk < 10% was 64.0%. Our investigation indicates that women with a mean age of 60 years, unclear chest pain and without exercise induced ischemia are highly suspected to have initial coronary arteriosclerosis, when a distinct risk factor profile and a 10-year cardiac event risk > 10% are present. For this high risk group of women, intensive secondary prevention measures are necessary.
由于性别特异性因素，女性冠心病的病理生理学和预后是深入的流行病学和临床研究的主题。我们评估了36例连续的疑似冠心病女性（平均年龄59.7岁）中可改变的冠心病危险因素的患病率，这些女性因胸痛原因不明而接受了冠状动脉造影。17名女性冠状动脉造影显示冠状动脉正常（I组），19名女性显示冠状动脉有初期动脉硬化（管腔直径缩小<35%）（II组）。I组平均年龄为59.1岁，II组为60.3岁（p=无统计学意义）。在过去6个月内没有女性服用降脂药物。在任何情况下均未进行激素替代疗法。与II组女性相比，I组女性的总胆固醇和低密度脂蛋白胆固醇水平显著更高（分别为271.6±34.3 vs 243.5±44.8mg/dl；p<0.005和190.5±36.8 vs 149.7±45.1mg/dl；p<0.025），高密度脂蛋白胆固醇值显著更低（57.8±16.5 vs 72.8±19.1mg/dl；p<0.0125）。I组的总胆固醇/高密度脂蛋白胆固醇比值为3.6±1.2，II组为5.1±1.7（p<0.005）。存在初期冠状动脉粥样硬化且总胆固醇/高密度脂蛋白比值>4的阳性预测值为76.5%。阴性预测值和比值<4为81.3%。I组女性有1.2±0.9个危险因素，II组有1.6±0.8个危险因素（吸烟、高血压、体重指数>30kg/m2、糖尿病、高脂血症）（p<0.10）。I组发生冠状动脉事件的10年风险为9.1±3.7%，II组为14.2±5.8%（p<0.005）。存在初期冠状动脉粥样硬化且10年风险>10%的阳性预测值为90%。阴性预测值和10年风险<10%为64.0%。我们的研究表明，平均年龄60岁、胸痛原因不明且无运动诱发缺血的女性，当存在明显的危险因素谱且10年心脏事件风险>10%时，高度怀疑有初期冠状动脉硬化。对于这一高风险女性群体，强化二级预防措施是必要的。
