Reibis Rona, Treszl Andras, Wegscheider Karl, Bestehorn Kurt, Karmann Barbara, Völler Heinz
Department of Cardiology, Klinik am See, Rehabilitation Center of Cardiovascular Diseases, Rüdersdorf, Germany.
Vasc Health Risk Manag. 2012;8:473-81. doi: 10.2147/VHRM.S33305. Epub 2012 Aug 17.
There are few data available regarding the specificity and modifiability of major cardiovascular (CV) risk factors in patients with premature versus (vs) late-onset coronary artery disease (CAD). This study was designed to analyze and compare these risk factors.
Data from 15,381 consecutive patients (mean age, 62.3 ± 11.7 years; female, 33.8%) hospitalized with CAD were collected from a large-scale registry (Transparency Registry to Objectify Guideline-Oriented Risk Factor Management) and analyzed. The patients were divided into two groups, depending on age at inclusion: group 1 patients (n = 5725; mean age, 50.5 ± 7.2 years) were males aged < 55 years and females aged < 65 years; group 2 patients (n = 9656; mean age, 69.4 ± 7.4 years) were males aged > 55 years and females aged > 65 years and had a low-density lipoprotein cholesterol level of >100 mg/dL on admission to cardiac rehabilitation. Besides the conventional risk factors, lipoprotein(a) concentrations and glucose tolerance were measured facultatively. Univariate (chi-square test) and multivariate logistic regression models were used.
Cigarette smoking (group 1 at 31.5% vs group 2 at 9.4%; P < 0.001), family history of CAD (group 1 at 43.6% vs group 2 at 26.5%; P < 0.001), and dyslipidemia (group 1 at 92.7% vs group 2 at 91.8%; P < 0.001) were dominant risk factors in the younger group. Arterial hypertension (group 1 at 71.4% vs group 2 at 87.0%; P < 0.001) and diabetes (group 1 at 23.5% vs group 2 at 30.1%; P < 0.001) were dominant risk factors in the older group. Impaired glucose tolerance and diabetes were less frequent in the younger group (P(trend) = 0.038), and identical lipoprotein(a) concentration levels of >30 mg/dL were found in both groups (8.0%; P = 0.810). Modification of lipid profile and blood pressure was more effective in the younger group (low-density lipoprotein cholesterol < 100 mg/dL: group 1 at 66.3% vs group 2 at 61.1%; systolic blood pressure < 140 mmHg: group 1 at 91.7% vs group 2 at 83.0%; P < 0.001).
CV risk factors differ markedly between premature and non-premature CAD. Cardiac rehabilitation provides an opportunity to reinforce secondary prevention after acute coronary syndrome.
关于早发与晚发冠状动脉疾病（CAD）患者主要心血管（CV）危险因素的特异性和可改变性，现有数据较少。本研究旨在分析和比较这些危险因素。
从一个大型注册库（客观化以指南为导向的危险因素管理透明注册库）收集并分析了15381例因CAD住院的连续患者的数据（平均年龄62.3±11.7岁；女性占33.8%）。根据纳入时的年龄将患者分为两组：第1组患者（n = 5725；平均年龄50.5±7.2岁）为年龄<55岁的男性和年龄<65岁的女性；第2组患者（n = 9656；平均年龄69.4±7.4岁）为年龄>55岁的男性和年龄>65岁的女性，且在进入心脏康复治疗时低密度脂蛋白胆固醇水平>100mg/dL。除了传统危险因素外，还酌情测量了脂蛋白（a）浓度和糖耐量。使用单因素（卡方检验）和多因素逻辑回归模型。
吸烟（第1组为31.5%，第2组为9.4%；P<0.001）、CAD家族史（第1组为43.6%，第2组为26.5%；P<0.001）和血脂异常（第1组为92.7%，第2组为91.8%；P<0.001）是较年轻组的主要危险因素。动脉高血压（第1组为71.4%，第2组为87.0%；P<0.001）和糖尿病（第1组为23.5%，第2组为30.1%；P<0.001）是较年长组的主要危险因素。较年轻组糖耐量受损和糖尿病的发生率较低（P趋势=0.038），两组脂蛋白（a）浓度>30mg/dL的水平相同（8.0%；P = 0.810）。较年轻组在改善血脂谱和血压方面更有效（低密度脂蛋白胆固醇<100mg/dL：第1组为66.3%，第2组为61.1%；收缩压<140mmHg：第1组为91.7%，第2组为83.0%；P<0.001）。
早发与非早发CAD患者的CV危险因素存在显著差异。心脏康复为急性冠状动脉综合征后加强二级预防提供了机会。
