Meco J F, Pintó X, Escribà J M, Vela M, Jara F, Pallarés C, Castiñeiras M J, Pujol R
Bellvitge Hospital, Barcelona, Spain.
Eur J Clin Invest. 1998 Aug;28(8):643-50. doi: 10.1046/j.1365-2362.1998.00350.x.
Patients with coronary artery disease (CAD) associated with peripheral (PAD) or cerebrovascular disease (CVD), a condition called diffuse atherosclerosis, have a higher risk of death than patients with isolated CAD. The prevalence of diffuse atherosclerosis and the atherogenic risk factors associated with this condition in our geographic area have not been described previously.
A cohort of 2597 patients (62 +/- 10.8 years, 665 women) consecutively admitted at Bellvitge Hospital because of acute coronary syndromes were studied. CAD patients were divided in two groups with diffuse and located atherosclerosis according to whether they had or they had not an associated PAD or CVD. Baseline history, physical data and lipid profile were recorded in each patient according to a standardized questionnaire.
A total of 370 patients (14.2%) had diffuse atherosclerosis. Among them, there were more men and women older than 55 years than among those with isolated CAD. Patients with diffuse atherosclerosis were more frequently hypertensive, diabetic and former smokers than those with isolated CAD (60.5% vs. 49.4%, P < 0.01; 37.4% vs. 24.5%, P < 0.01; and 47% vs. 35.7%, P < 0.01, respectively). There were no significant differences in the mean values of total cholesterol (TC), low-density cholesterol (LDL-C), high-density cholesterol (HDL-C) and triglycerides between both groups of patients, but patients with diffuse atherosclerosis had a lower HDL-C/TC ratio, with borderline statistical significance (0.18 +/- 0.06 vs. 0.19 +/- 0.06, P = 0.06). Using multiple logistic regression analysis, the variables associated with diffuse atherosclerosis in men were age greater than 55 years (OR 1.97, CI 1.33-2.93), hypertension (OR 1.50, CI 1.14-2.20), diabetes (OR 1.78, CI 1.20-2.70), smoking (former smokers) (OR 2.09, CI 1.36-3.24) and HDL-C/TC < 0.20 (OR 1.60, CI 1.18-2.17); and in women hypertension (OR 3.43, CI 1.48-7.94) and diabetes (OR 2.58, CI 1.55-4.80).
Clinically overt diffuse atherosclerosis is a relatively common disease. Older patients and those with hypertension, diabetes or low HDL-C/TC ratio are more likely to have diffuse atherosclerosis than those without these conditions.
患有与外周血管疾病（PAD）或脑血管疾病（CVD）相关的冠状动脉疾病（CAD）（一种称为弥漫性动脉粥样硬化的病症）的患者比患有孤立性CAD的患者死亡风险更高。此前尚未描述过我们所在地理区域中弥漫性动脉粥样硬化的患病率以及与此病症相关的致动脉粥样硬化危险因素。
对因急性冠脉综合征连续入住贝尔维奇医院的2597例患者（62±10.8岁，665名女性）进行了研究。根据CAD患者是否伴有PAD或CVD，将其分为弥漫性动脉粥样硬化组和局限性动脉粥样硬化组。根据标准化问卷记录每位患者的基线病史、体格数据和血脂谱。
共有370例患者（14.2%）患有弥漫性动脉粥样硬化。其中，年龄大于55岁的男性和女性比患有孤立性CAD的患者更多。与孤立性CAD患者相比，弥漫性动脉粥样硬化患者高血压、糖尿病和既往吸烟者更为常见（分别为60.5%对49.4%，P<0.01；37.4%对24.5%，P<0.01；47%对35.7%，P<0.01）。两组患者的总胆固醇（TC）、低密度胆固醇（LDL-C）、高密度胆固醇（HDL-C）和甘油三酯的平均值无显著差异，但弥漫性动脉粥样硬化患者的HDL-C/TC比值较低，具有临界统计学意义（0.18±0.06对0.19±0.06，P=0.06）。使用多因素逻辑回归分析，男性中与弥漫性动脉粥样硬化相关的变量为年龄大于55岁（OR 1.97，CI 1.33 - 2.93）、高血压（OR 1.50，CI 1.14 - 2.20）、糖尿病（OR 1.78，CI 1.20 - 2.70）、吸烟（既往吸烟者）（OR 2.09，CI 1.36 - 3.24）和HDL-C/TC<0.20（OR 1.60，CI 1.18 - 2.17）；女性中为高血压（OR 3.43，CI 1.48 - 7.94）和糖尿病（OR 2.58，CI 1.55 - 4.80）。
临床上明显的弥漫性动脉粥样硬化是一种相对常见的疾病。老年患者以及患有高血压、糖尿病或HDL-C/TC比值低的患者比没有这些情况的患者更易患弥漫性动脉粥样硬化。
