McNicoll S, Latour Y, Rondeau C, Bouthillier D, Davignon J, Genest J
Cardiovascular Genetics Laboratory, Institut de Recherches Cliniques de Montréal, Québec.
Can J Cardiol. 1995 Feb;11(2):109-16.
Coronary artery disease (CAD) is the major cause of death in Canadian adults. Regional differences in the prevalence of CAD in Canada are due, in part, to differences in cardiovascular risk factor distribution. Two hundred and forty-nine patients of predominantly French Canadian descent (greater than 90%), aged less than 60 years (202 men and 47 women) with angiographically documented CAD were examined in a cardiology secondary prevention clinic and their cardiovascular risk factors and lipoprotein cholesterol levels were determined.
To determine the prevalence of cardiovascular risk factors in a group of French Canadian subjects compared with subjects screened for the Quebec Heart Health Survey and to determine the impact of the National Cholesterol Education Program II (NCEP II) on screening and treatment of these patients.
Observation study of free-living subjects with CAD, compared with a reference group.
Mean ages were 48.6 +/- 6.8 and 50.6 +/- 6.4 years for men and women, respectively. On average, the patients were on a diet containing approximately 31% of calories as fat, with 9.7% as saturated fats at the time of blood sampling. The mean number of risk factors was the same in men and women (3.5 +/- 1.2 for men versus 3.2 +/- 1.3 for women; P not significant) but their prevalence differed between sexes. Family history of CAD was seen in 78.5% of men versus 77.3% of women (P not significant), smoking (defined as more than 10 cigarettes per day in the year preceding the clinical evaluation) in 45.7% of men versus 41.9% of women (P not significant), a history of smoking in 75.5% of men versus 69.8% of women (P not significant) and diabetes in 14.7% of men and 25% of women (P not significant). There was less hypertension in men (31.4% versus 52.3%, P = 0.015) and fewer men had a low density lipoprotein cholesterol of 3.4 mmol/L or greater (66.8% in men versus 83% in women, P < 0.05). Men, however, had a higher prevalence of reduced high density lipoprotein cholesterol (less than 0.9 mmol/L, 57.4% in men versus 31.9% in women, P < 0.01). Only approximately 5% of premature CAD patients had familial hypercholesterolemia. Compared with a reference group from the Quebec Heart Health Survey, men and women with CAD had a higher prevalence of cardiovascular risk factors. With a cut-off point for total cholesterol of 5.2 mmol/L, 26.2% of men and 17% of women had 'normal' cholesterol levels; of these, 67.9% of men and 25% of women had high density lipoprotein less than 0.9 mmol/L.
French Canadian men and women with CAD have a high prevalence of all cardiovascular risk factors. The patients are representative of the Montreal urban area and findings of the present study may not apply to the Quebec population with respect to the prevalence of risk factors. Under the treatment recommendations of NCEP II, 66.8% of men and 83% of women are candidates for drug therapy of dyslipoproteinemia aimed at reducing low density lipoprotein cholesterol levels. According to these data, cardiovascular risk stratification must be based on a complete lipoprotein profile or misclassification, especially in men, may occur.
冠状动脉疾病（CAD）是加拿大成年人的主要死因。加拿大CAD患病率的地区差异部分归因于心血管危险因素分布的不同。在一家心脏病二级预防诊所对249名主要为法裔加拿大人后裔（超过90%）、年龄小于60岁（202名男性和47名女性）且经血管造影证实患有CAD的患者进行了检查，并测定了他们的心血管危险因素和脂蛋白胆固醇水平。
确定一组法裔加拿大受试者中心血管危险因素的患病率，并与魁北克心脏健康调查筛查的受试者进行比较，同时确定国家胆固醇教育计划II（NCEP II）对这些患者筛查和治疗的影响。
对患有CAD的自由生活受试者进行观察性研究，并与一个参考组进行比较。
男性和女性的平均年龄分别为48.6±6.8岁和50.6±6.4岁。平均而言，患者在采血时的饮食中脂肪提供的热量约为31%，其中饱和脂肪占9.7%。男性和女性的危险因素平均数量相同（男性为3.5±1.2，女性为3.2±1.3；P无显著性差异），但其患病率在性别之间存在差异。CAD家族史在78.5%的男性和77.3%的女性中出现（P无显著性差异），吸烟（定义为临床评估前一年每天吸烟超过10支）在45.7%的男性和41.9%的女性中出现（P无显著性差异），有吸烟史在75.5%的男性和69.8%的女性中出现（P无显著性差异），糖尿病在14.7%的男性和25%的女性中出现（P无显著性差异）。男性高血压患者较少（31.4%对52.3%，P = 0.015），低密度脂蛋白胆固醇≥3.4 mmol/L的男性也较少（男性为66.8%，女性为83%，P < 0.05）。然而，男性高密度脂蛋白胆固醇降低（<0.9 mmol/L）的患病率更高（男性为57.4%，女性为31.9%，P < 0.01）。只有约5%的早发性CAD患者患有家族性高胆固醇血症。与魁北克心脏健康调查的参考组相比，患有CAD的男性和女性心血管危险因素的患病率更高。总胆固醇切点为5.2 mmol/L时，26.2%的男性和17%的女性胆固醇水平“正常”；其中，67.9%的男性和25%的女性高密度脂蛋白<0.9 mmol/L。
患有CAD的法裔加拿大男性和女性所有心血管危险因素的患病率都很高。这些患者代表了蒙特利尔市区，本研究结果在危险因素患病率方面可能不适用于魁北克人群。根据NCEP II的治疗建议，66.8%的男性和83%的女性是旨在降低低密度脂蛋白胆固醇水平的血脂异常药物治疗的候选者。根据这些数据，心血管风险分层必须基于完整的脂蛋白谱，否则可能会出现错误分类，尤其是在男性中。
