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Risk factors and the anatomic distribution of coronary artery disease
D S Freedman1, H W Gruchow, S J Jacobsen
1Division of Biostatistics and Clinical Epidemiology, Medical College of Wisconsin, Milwaukee 53226.
Insights
Coronary artery disease (CAD) risk factors vary by location. Left main (LM) CAD is poorly predicted by standard factors like cholesterol, unlike disease in other coronary arteries.
Area of Science:
- Cardiology
- Epidemiology
Background:
- Coronary artery disease (CAD) risk factors are well-established.
- However, their predictive value may differ based on the anatomic location of stenotic disease.
Purpose of the Study:
- To assess how the importance of various risk factors differs according to the specific location of coronary artery disease (CAD).
Main Methods:
- Arteriography was performed on 4722 men and 1069 women.
- Key risk factors analyzed included cholesterol levels, triglycerides, obesity, smoking, alcohol consumption, diabetes, and hypertension.
Main Results:
- The ratio of total to HDL-cholesterol strongly correlated with overall CAD severity but weakly with left main (LM) disease.
- Other risk factors also showed weaker associations with LM disease compared to stenoses in other coronary vessels.
- LM disease was poorly predicted by standard risk factors, even after adjusting for disease in other vessels.
Conclusions:
- The relationship between cardiovascular risk factors and CAD is location-dependent.
- Standard risk factors are not effective predictors of left main coronary artery disease.
Abstract:
Differences in the importance of risk factors according to the anatomic location of coronary artery disease (CAD) were assessed in 4722 men and 1069 women who underwent arteriography. Examined characteristics included total and high-density lipoprotein (HDL)-cholesterol, triglycerides, obesity, smoking, alcohol consumption, diabetes, and hypertension. Of these risk factors, the ratio of total to HDL-cholesterol showed the highest correlation with the overall severity of CAD (r = 0.24, men; r = 0.38, women); in contrast, its relation to left main (LM) disease was much lower (r = 0.10, men; r = 0.08 women) than were correlations with stenotic disease in the left anterior descending, circumflex, and right coronary arteries. Other risk factors also showed weaker associations with LM disease than with stenoses in other vessels, and none was related to increased LM disease after controlling for disease in other vessels. For example, as compared with men who had no significant CAD, those with 1-, 2-, and 3-vessel disease had mean increases in total cholesterol of 12, 18, and 19 mg/dl, respectively. In contrast, after adjusting for disease in other vessels, LM disease (present in 293 men) was associated with only a 4 mg/dl increase in mean cholesterol levels (P = 0.20). These results indicate that the relation of risk factors to CAD differs according to the location of the stenotic disease, and that LM disease is poorly predicted by the standard risk factors.