Lavie Carl J, Milani Richard V
Department of Cardiology, Ochsner Clinic Foundation, New Orleans, LA 70121, USA.
Mayo Clin Proc. 2005 Mar;80(3):335-42. doi: 10.4065/80.3.335.
To determine the prevalence of hostility symptoms in young patients with coronary artery disease (CAD), the associated risk factor profile in these patients, and the effects of a formal phase 2 cardiac rehabilitation and exercise training program.
Our study included consecutive CAD patients referred for cardiac rehabilitation from May 1999 through December 2000. At baseline and after rehabilitation, behavioral factors and quality of life were assessed by validated questionnaires, and standard CAD risk factors were measured, including exercise capacity. We specifically evaluated detailed data for young patients.
A total of 500 patients were included in the study. Hostility scores were 2.5 times higher (P<.001) in the 81 young patients (< 50 years; mean +/- SD age, 45 +/- 5 years) than in the 268 elderly patients (> or = 65 years; mean +/- SD age, 70 +/- 4 years), and the prevalence of hostility symptoms was 3.5 times higher in young patients (28% vs 8%; P<.001). Young patients with hostility symptoms also had more adverse CAD risk profiles, including higher total cholesterol levels, triglyceride levels, total cholesterol/high-density lipoprotein cholesterol ratios, fasting glucose levels, and glycosylated hemoglobin levels and lower quality-of-life scores compared with young patients with low hostility scores. After cardiac rehabilitation, young patients with hostility symptoms had marked improvements in CAD risk factors, behavioral characteristics (including hostility), and quality of life, and a nearly 50% (P=.005) reduction in the prevalence of hostility symptoms occurred.
Young CAD patients have a high prevalence of hostility symptoms and adverse CAD risk profiles. Reducing hostility symptoms and other parameters of psychological distress in young CAD patients should be emphasized, and the potential benefits of cardiac rehabilitation programs in the secondary prevention of CAD should be highlighted.
确定年轻冠心病（CAD）患者中敌意症状的患病率、这些患者的相关危险因素概况，以及正式的二期心脏康复和运动训练计划的效果。
我们的研究纳入了1999年5月至2000年12月期间因心脏康复而转诊的连续CAD患者。在基线和康复后，通过经过验证的问卷评估行为因素和生活质量，并测量标准的CAD危险因素，包括运动能力。我们专门评估了年轻患者的详细数据。
共有500名患者纳入研究。81名年轻患者（<50岁；平均±标准差年龄，45±5岁）的敌意得分比268名老年患者（≥65岁；平均±标准差年龄，70±4岁）高2.5倍（P<0.001），年轻患者中敌意症状的患病率高3.5倍（28%对8%；P<0.001）。与低敌意得分的年轻患者相比，有敌意症状的年轻患者还具有更多不良的CAD危险因素，包括更高的总胆固醇水平、甘油三酯水平、总胆固醇/高密度脂蛋白胆固醇比值、空腹血糖水平和糖化血红蛋白水平，以及更低的生活质量得分。心脏康复后，有敌意症状的年轻患者在CAD危险因素、行为特征（包括敌意）和生活质量方面有显著改善，敌意症状的患病率降低了近50%（P=0.005）。
年轻CAD患者中敌意症状和不良CAD危险因素的患病率较高。应强调降低年轻CAD患者的敌意症状和心理困扰的其他参数，并突出心脏康复计划在CAD二级预防中的潜在益处。
