Ortlepp J R, Schmitz F, Bozoglu T, Hanrath P, Hoffmann R
Medical Clinic I, University Hospital of Aachen, Germany.
Heart. 2003 Sep;89(9):1019-22. doi: 10.1136/heart.89.9.1019.
Traditional cardiovascular risk factors have been associated with aortic stenosis and coronary artery disease. As these two conditions often co-exist, the association of cardiovascular risk factors with aortic stenosis may reflect confounding.
To compare the cardiovascular risk profile in patients with severe aortic stenosis undergoing elective coronary angiography with that of patients without aortic stenosis or calcification undergoing coronary angiography for suspected coronary artery disease.
523 patients referred for elective diagnostic left heart catheterisation because of severe aortic stenosis formed the case population; 3925 patients without valve disease referred for elective diagnostic left heart catheterisation formed the base control population. Of the latter, 523 were pair matched to the case population for sex, age, and prevalence of relevant coronary artery disease, forming a pair matched control population. Cardiovascular risk factors (male sex, hypertension, hypercholesterolaemia, smoking, diabetes mellitus, family history of coronary artery disease) were assessed in all the patients.
None of the cardiovascular risk factors was more prevalent in patients with aortic stenosis than in the base control population or in the pair matched control population. However, male sex, hypercholesterolaemia, smoking, diabetes mellitus, and a family history of coronary artery disease were significantly associated with the presence of additional coronary artery disease in patients with aortic stenosis.
Cardiovascular risk factors are commonly present in patients with aortic stenosis. However, when compared with controls matched for age, sex, and angiographically defined coronary artery disease, no risk factor was significantly associated with the prevalence of aortic stenosis. Thus other factors are likely to be more important in the pathogenesis of aortic stenosis.
传统心血管危险因素与主动脉瓣狭窄和冠状动脉疾病相关。由于这两种情况常同时存在，心血管危险因素与主动脉瓣狭窄之间的关联可能反映了混杂因素。
比较因严重主动脉瓣狭窄接受择期冠状动脉造影的患者与因疑似冠状动脉疾病接受冠状动脉造影但无主动脉瓣狭窄或钙化的患者的心血管风险特征。
因严重主动脉瓣狭窄转诊接受择期诊断性左心导管检查的523例患者构成病例组；因无瓣膜疾病转诊接受择期诊断性左心导管检查的3925例患者构成基础对照组。后者中，523例按性别、年龄和相关冠状动脉疾病患病率与病例组进行配对，形成配对对照组。对所有患者评估心血管危险因素（男性、高血压、高胆固醇血症、吸烟、糖尿病、冠状动脉疾病家族史）。
主动脉瓣狭窄患者中，没有一种心血管危险因素比基础对照组或配对对照组更普遍。然而，男性、高胆固醇血症、吸烟、糖尿病和冠状动脉疾病家族史与主动脉瓣狭窄患者合并其他冠状动脉疾病显著相关。
心血管危险因素在主动脉瓣狭窄患者中普遍存在。然而，与年龄、性别和血管造影定义的冠状动脉疾病相匹配的对照组相比，没有危险因素与主动脉瓣狭窄的患病率显著相关。因此，其他因素可能在主动脉瓣狭窄的发病机制中更为重要。
