Wilt T J, Rubins H B, Collins D, O'Connor T Z, Rutan G H, Robins S J
Section of General Internal Medicine, Minneapolis VAMC, MN 55417, USA.
Arch Intern Med. 1996 Jun 10;156(11):1181-8.
Peripheral atherosclerosis is a strong and independent predictor of mortality even in patients with known coronary heart disease. However, the prevalence, correlates, and potential adverse effects on quality of life associated with combined coronary heart disease and clinically evident cerebrovascular or lower-extremity atherosclerosis are not known. Identification of patients with "diffuse atherosclerosis" may enhance treatment of modifiable risk factors and alter therapeutic strategies.
We conducted a cross-sectional analysis of 2531 men younger than 73 years with coronary heart disease, low-density lipoprotein cholesterol levels of 3.62 mmol/L (140 mg/dL) or less, and high-density lipoprotein cholesterol level of 1.03 mmol/L (40 mg/dL) or less who were participating in Department of Veterans Affairs Cooperative Study 363 (the Veterans Affairs High-Density Lipo-protein Intervention Trial. Baseline demographic, medication, comorbidity, and atherosclerotic risk factor data were assessed by means of a standardized questionnaire. All plasma lipid levels were determined after a 12-hour fast by a central standardized lipid laboratory. Health status was determined by baseline reported symptoms, medical comorbidities, and the Psychological General Well-being Index. Clinically evident diffuse atherosclerosis was defined as a documented history of lower-extremity atherosclerosis or cerebrovascular disease.
The mean age of all participants was 63.5 years. The mean plasma lipid values were as follows: total cholesterol, 4,52 mmol/L (174.6 mg/dL); high-density lipo-protein cholesterol, 0.81 mmol/L (31.5 mg/dL); low-density lipoprotein cholesterol, 2.88 mmol/L (111.2 mg/dL); and triglycerides, 1.81 mmol/L (160.6 mg/dL). Diffuse atherosclerosis was present in 525 (21%). Lower-extremity atherosclerosis was reported in 10%, while cerebrovascular disease was present in 13%. After controlling for other variables, the following factors were associated with the presence of diffuse atherosclerosis: increased age, being unmarried, being retired, having less than a high school education, increased alcohol use, hypertension, cigarette smoking, and diabetes. There was no association between lipid levels and the presence of diffuse atherosclerosis. After adjustment for age, race, and comorbidities, men with diffuse disease still had a reduced quality of life compared with men without diffuse atherosclerosis, as defined by having a greater number of clinical symptoms, lower psychological well-being scores, and more advanced or complicated coronary heart disease.
Clinically evident diffuse atherosclerosis is common in men with coronary heart disease and low levels of high-density lipoprotein cholesterol. Because diffuse atherosclerosis is associated with a reduced quality of life and several modifiable risk factors, early detection and aggressive risk factor intervention appear justified.
外周动脉粥样硬化是死亡率的一个强有力的独立预测因素，即使在已知患有冠心病的患者中也是如此。然而，合并冠心病和临床明显的脑血管或下肢动脉粥样硬化的患病率、相关因素以及对生活质量的潜在不良影响尚不清楚。识别患有“弥漫性动脉粥样硬化”的患者可能会加强对可改变危险因素的治疗并改变治疗策略。
我们对2531名年龄小于73岁、患有冠心病、低密度脂蛋白胆固醇水平为3.62 mmol/L（140 mg/dL）或更低且高密度脂蛋白胆固醇水平为1.03 mmol/L（40 mg/dL）或更低的男性进行了横断面分析，这些男性参与了退伍军人事务部合作研究363（退伍军人事务部高密度脂蛋白干预试验）。通过标准化问卷评估基线人口统计学、用药、合并症和动脉粥样硬化危险因素数据。所有血脂水平均在禁食12小时后由中央标准化血脂实验室测定。健康状况由基线报告的症状、医学合并症和心理总体幸福感指数确定。临床明显的弥漫性动脉粥样硬化定义为有下肢动脉粥样硬化或脑血管疾病的记录病史。
所有参与者的平均年龄为63.5岁。平均血脂值如下：总胆固醇4.52 mmol/L（174.6 mg/dL）；高密度脂蛋白胆固醇0.81 mmol/L（31.5 mg/dL）；低密度脂蛋白胆固醇2.88 mmol/L（111.2 mg/dL）；甘油三酯1.81 mmol/L（160.6 mg/dL）。525名（21%）存在弥漫性动脉粥样硬化。报告有下肢动脉粥样硬化的占10%，存在脑血管疾病的占13%。在控制其他变量后，以下因素与弥漫性动脉粥样硬化的存在相关：年龄增加、未婚、退休、高中以下学历、饮酒增加、高血压、吸烟和糖尿病。血脂水平与弥漫性动脉粥样硬化的存在之间无关联。在对年龄、种族和合并症进行调整后，与没有弥漫性动脉粥样硬化的男性相比，患有弥漫性疾病的男性生活质量仍然较低，这表现为有更多的临床症状、更低的心理健康评分以及更晚期或更复杂的冠心病。
临床明显的弥漫性动脉粥样硬化在患有冠心病且高密度脂蛋白胆固醇水平较低的男性中很常见。由于弥漫性动脉粥样硬化与生活质量降低以及几个可改变的危险因素相关，早期检测和积极的危险因素干预似乎是合理的。
