Ko Dennis T, Wijeysundera Harindra C, Udell Jacob A, Vaccarino Viola, Austin Peter C, Guo Helen, Velianou James L, Lau Kelly, Tu Jack V
Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada; Schulich Heart Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada; Schulich Heart Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
Can J Cardiol. 2014 Jul;30(7):820-6. doi: 10.1016/j.cjca.2014.04.032. Epub 2014 May 2.
Extensive research has demonstrated the importance of traditional cardiovascular risk factors in predicting acute coronary events. Our main objective was to evaluate the relationship between traditional risk factors and the presence of obstructive coronary artery disease (CAD), and to explore potential differences in men vs women.
An observational study was conducted in a population-based cohort of stable patients who underwent cardiac catheterization in Ontario, Canada. We examined the relationship of diabetes, hypertension, hyperlipidemia, and smoking with the presence of obstructive CAD in men and women using multivariable logistic regression models.
Of the 46,490 patients who were included in our study, 61.2% were men and 38.8% were women. We found that 97% of patients with obstructive CAD had at least 1 conventional cardiovascular risk factor. The adjusted odds ratios (ORs) for obstructive CAD in women with diabetes (OR, 1.51), hypertension (OR, 1.38), and smoking (OR, 1.39) were statistically significantly greater than in men (OR, 1.20 for diabetes; OR, 1.08 for hypertension; OR, 1.14 for smoking; P < 0.001). The sex difference was even greater for patients with multiple risk factors. For example, the association with obstructive CAD in women with 4 cardiac risk factors (OR, 4.30; 95% confidence interval, 3.49-5.28) was almost doubled compared with men (OR, 2.26; 95%confidence interval, 1.99-2.57; P < 0.001).
Almost all patients with stable CAD undergoing cardiac catheterization had at least 1 traditional cardiac risk factor. Importantly, the association between multiple cardiac risk factors and the presence of obstructive CAD is substantially stronger in women than men.
大量研究已证明传统心血管危险因素在预测急性冠脉事件中的重要性。我们的主要目标是评估传统危险因素与阻塞性冠状动脉疾病（CAD）的存在之间的关系，并探讨男性与女性之间的潜在差异。
在加拿大安大略省一个以人群为基础的稳定患者队列中进行了一项观察性研究，这些患者接受了心脏导管插入术。我们使用多变量逻辑回归模型研究了糖尿病、高血压、高脂血症和吸烟与男性和女性阻塞性CAD存在之间的关系。
在纳入我们研究的46490例患者中，61.2%为男性，38.8%为女性。我们发现，97%的阻塞性CAD患者至少有1种传统心血管危险因素。患有糖尿病（比值比[OR]，1.51）、高血压（OR，1.38）和吸烟（OR，1.39）的女性发生阻塞性CAD的校正OR在统计学上显著高于男性（糖尿病OR为1.20；高血压OR为1.08；吸烟OR为1.14；P<0.001）。对于有多种危险因素的患者，性别差异更大。例如，有4种心脏危险因素的女性与阻塞性CAD的关联（OR，4.30；95%置信区间，3.49 - 5.28）与男性相比几乎翻倍（OR，2.26；95%置信区间，1.99 - 2.57；P<0.001）。
几乎所有接受心脏导管插入术的稳定CAD患者至少有1种传统心脏危险因素。重要的是，多种心脏危险因素与阻塞性CAD存在之间的关联在女性中比男性更强。
