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Risk factors that discriminate 'high- risk' from 'low-risk' Japanese patients with coronary artery disease
1The Second Department of Internal Medicine, Kansai Electric Power Hospital, Osaka, Japan. K-21568@kepco.co.jp
Insights
Diabetes mellitus (DM), low high-density lipoprotein (HDL)-cholesterol, and high lipoprotein (Lp)(a) are key predictors for high-risk coronary artery disease (CAD). Low HDL-cholesterol is the sole predictor in patients with significant coronary stenosis or left ventricular dysfunction.
Area of Science:
- Cardiology
- Internal Medicine
- Public Health
Background:
- Coronary artery disease (CAD) progression is influenced by various risk factors.
- Long-term prognostic factors for high-risk CAD remain incompletely defined.
Purpose of the Study:
- To identify specific coronary risk factors associated with long-term prognosis in high-risk Japanese patients with CAD.
- To compare risk factor prevalence between high-risk and low-risk CAD patient groups.
Main Methods:
- Enrolled 311 Japanese CAD patients undergoing coronary arteriography.
- Classified patients into high-risk (impaired left ventricular function or multivessel disease) and low-risk groups.
- Compared prevalence of risk factors including diabetes mellitus (DM), lipid profiles, and lipoprotein (Lp)(a).
Main Results:
- High-risk patients showed significantly higher prevalence of DM, low high-density lipoprotein (HDL)-cholesterol (<35 mg/dl), and high lipoprotein (Lp)(a) (>25 mg/dl).
- DM, low HDL-cholesterol, and high Lp(a) were independent predictors for high-risk CAD.
- Low HDL-cholesterol was the sole independent predictor for high-risk CAD when patients with 0-vessel disease were excluded.
Conclusions:
- Diabetes mellitus, low HDL-cholesterol, and high Lp(a) are significant predictors of high-risk CAD.
- Low HDL-cholesterol is the primary predictor for high-risk CAD in patients with significant coronary stenosis or left ventricular dysfunction.
Abstract:
Although various risk factors have been implicated in the progression of coronary artery disease (CAD), coronary risk factors specifically related to the long-term prognosis for high-risk CAD have not been determined. The study enrolled 311 consecutive Japanese patients with CAD who underwent diagnostic coronary arteriography and divided them into 2 groups: (i) 135 high-risk patients with either impaired left ventricular function (ejection fraction <50%) or multivessel disease and (ii) 176 low-risk patients with normal left ventricular function and 0- or 1-vessel disease. The prevalence of risk factors including age, gender, smoking, hypertension, diabetes mellitus (DM), obesity and lipid variables were compared between the 2 groups. The prevalence of DM, a serum high-density lipoprotein (HDL)-cholesterol level below 35 mg/dl and a serum lipoprotein (Lp) (a) level above 25 mg/dl was significantly higher in the high-risk group as compared with the low-risk group. Multiple logistic regression analysis demonstrated that DM (odds ratio (OR): 1.72, 95% confidence intervals (CI): 1.02-2.92, p<0.05), a low HDL-cholesterol level (OR: 2.49, 95% CI: 1.49-4.17, p<0.001) and a high Lp(a) level (OR: 1.68, 95% CI: 1.02-2.76, p<0.05) were all independent risk factors for high-risk CAD. However, if the patients with 0-vessel disease were excluded from the low-risk group, a low HDL-cholesterol level was found to be the only independent predictor for high-risk CAD (OR: 2.07, 95% CI: 1.15-3.70, p<0.05). Among both men and smokers in this population, a higher Lp(a) level was found to be a significant predictor for high-risk CAD. A low serum level of HDL-cholesterol, a high serum level of Lp(a) and DM were significant predictors of high-risk in patients with CAD. Among patients with a significant coronary stenosis or left ventricular dysfunction, a low serum level of HDL-cholesterol was the only significant predictor for high-risk CAD.