[Risk factors in stable coronary disease. Relationship with ischemic threshold and prognostic implications]

Area of Science:

• Cardiology
• Clinical Medicine
• Preventive Cardiology

Background:

• Assessing the 5-year clinical evolution of acute coronary syndromes in stable angina patients.
• Investigating the relationship between ischemic threshold (IT) and modifiable cardiovascular risk factors.
• Understanding the long-term prognosis of stable coronary artery disease.

Purpose of the Study:

• To evaluate the clinical progression of acute coronary syndromes in patients with stable angina over a 5-year follow-up period.
• To determine the association between the ischemic threshold (IT) and the development of acute coronary syndromes.
• To identify the impact of modifiable cardiovascular risk factors on the clinical course of stable angina.

Main Methods:

• 120 patients with stable angina underwent baseline exercise testing to characterize their ischemic threshold (IT).
• Patients were followed for 5 years, recording the incidence of acute myocardial infarction, unstable angina, and cardiac death.
• Cox hazard function and multivariant analyses were applied to assess risk factors and IT changes.

Main Results:

• 88% of patients had at least one cardiovascular risk factor (hypertension, hypercholesterolemia, diabetes, smoking).
• Patients whose IT changed from variable to fixed showed a significantly higher risk of acute coronary syndromes (44.5% vs. 12.5-20%).
• Hypertension and hypercholesterolemia predicted changes in the IT, identifying a high-risk subgroup.

Conclusions:

• High prevalence of cardiovascular risk factors in stable coronary artery disease necessitates aggressive management.
• Modification of the ischemic threshold is a significant predictor of adverse cardiovascular events.
• Identifying patients with hypertension and hypercholesterolemia who experience IT changes allows for early detection of high-risk individuals for acute coronary pathology.