Larifla Laurent, Armand Christophe, Velayoudom-Cephise Fritz-Line, Weladji Guy, Michel Carl Thony, Blanchet-Deverly Anne, Deloumeaux Jacqueline, Foucan Lydia
Cardiology Unit, University Hospital of Pointe-à-Pitre, 97159 Pointe-à-Pitre, Guadeloupe; Research Group, Clinical Epidemiology and Medicine, University of Antilles and Guyana, Pointe-à-Pitre, Guadeloupe.
Research Group, Clinical Epidemiology and Medicine, University of Antilles and Guyana, Pointe-à-Pitre, Guadeloupe; Department of Public Health and Medical Information, University Hospital of Pointe-à-Pitre, Pointe-à-Pitre, Guadeloupe.
Arch Cardiovasc Dis. 2014 Apr;107(4):212-8. doi: 10.1016/j.acvd.2014.03.003. Epub 2014 Apr 29.
Traditional risk factors are strong predictors of the incidence of coronary artery disease (CAD), but their association with disease severity remains controversial and could differ across ethnic groups.
In this study, we assessed the prevalence of cardiovascular risk factors (CRFs) in Afro-Caribbean patients with documented CAD, and sought to identify which of these factors are related to disease severity.
We retrospectively studied 420 consecutive patients with CAD. Disease severity was determined from the results of invasive coronary angiography, based on the presence or absence of multiple (two or three) diseased vessels and the myocardial jeopardy (MJ) score.
In the studied population (mean age 64.7 ± 12.4 years), hypertension, diabetes and dyslipidaemia were the most frequent modifiable CRFs, present in 75.9, 47.8 and 37.8% of patients, respectively. Multiple logistic regression analysis showed that diabetes, male sex and personal cardiovascular history significantly increased the risk of multivessel CAD: odds ratios (ORs) of 1.53 (1.01-2.33; P=0.048), 1.61 (1.02-2.55; P=0.043) and 1.68 (1.11-2.56; P=0.015), respectively. Obesity was an independent negative predictor, with an OR of 0.48 (0.29-0.79; P=0.004). Other traditional CRFs (hypertension, dyslipidaemia, smoking, age and family history of vascular disease) were not associated with CAD severity. For high-risk lesions (MJ score ≥8), both diabetes and hypertension were independent predictors of disease severity, whereas obesity was no longer a protective factor.
Diabetes emerged as the strongest modifiable risk factor predictor of multivessel disease in Afro-Caribbean patients, whereas obesity was an independent protective factor. The underlying mechanisms of these associations should be relevant to disease prevention.
传统危险因素是冠状动脉疾病（CAD）发病的有力预测指标，但其与疾病严重程度的关联仍存在争议，且可能因种族而异。
在本研究中，我们评估了有记录的CAD非洲加勒比裔患者心血管危险因素（CRF）的患病率，并试图确定哪些因素与疾病严重程度相关。
我们回顾性研究了420例连续的CAD患者。根据侵入性冠状动脉造影结果，基于是否存在多支（两支或三支）病变血管以及心肌危险（MJ）评分来确定疾病严重程度。
在研究人群（平均年龄64.7±12.4岁）中，高血压、糖尿病和血脂异常是最常见的可改变CRF，分别存在于75.9%、47.8%和37.8%的患者中。多因素逻辑回归分析显示，糖尿病、男性性别和个人心血管病史显著增加了多支血管CAD的风险：比值比（OR）分别为1.53（1.01 - 2.33；P = 0.048）、1.61（1.02 - 2.55；P = 0.043）和1.68（1.11 - 2.56；P = 0.015）。肥胖是一个独立的负性预测因素，OR为0.48（0.29 - 0.79；P = 0.004）。其他传统CRF（高血压、血脂异常、吸烟、年龄和血管疾病家族史）与CAD严重程度无关。对于高危病变（MJ评分≥8），糖尿病和高血压都是疾病严重程度的独立预测因素，而肥胖不再是保护因素。
糖尿病是非洲加勒比裔患者多支血管疾病最强的可改变危险因素预测指标，而肥胖是一个独立的保护因素。这些关联的潜在机制应与疾病预防相关。
