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Correlates and consequences of diffuse atherosclerosis in men with coronary heart disease. Veterans Affairs
T J Wilt1, H B Rubins, D Collins
1Section of General Internal Medicine, Minneapolis VAMC, MN 55417, USA.
Insights
Diffuse atherosclerosis, common in men with coronary heart disease, is linked to a lower quality of life. Early detection and intervention for risk factors like smoking and diabetes are crucial for managing this condition.
Area of Science:
- Cardiovascular Medicine
- Vascular Biology
- Public Health
Background:
- Peripheral atherosclerosis predicts mortality in coronary heart disease (CHD) patients.
- Prevalence, correlates, and quality of life impact of combined CHD and cerebrovascular/lower-extremity atherosclerosis are unknown.
- Identifying "diffuse atherosclerosis" may improve risk factor management and therapeutic strategies.
Purpose of the Study:
- To determine the prevalence and correlates of diffuse atherosclerosis in men with CHD.
- To assess the impact of diffuse atherosclerosis on quality of life.
- To identify factors associated with diffuse atherosclerosis for targeted interventions.
Main Methods:
- Cross-sectional analysis of 2531 men aged <73 with CHD and specific lipid profiles.
- Data collected via standardized questionnaire on demographics, medications, comorbidities, and risk factors.
- Diffuse atherosclerosis defined by documented lower-extremity or cerebrovascular disease.
Main Results:
- 21% of participants had diffuse atherosclerosis (10% lower-extremity, 13% cerebrovascular).
- Associated factors included older age, being unmarried/retired, lower education, alcohol use, hypertension, smoking, and diabetes.
- No association found between lipid levels and diffuse atherosclerosis.
- Diffuse atherosclerosis correlated with reduced quality of life, more symptoms, lower psychological well-being, and more complex CHD.
Conclusions:
- Clinically evident diffuse atherosclerosis is prevalent in men with CHD and low HDL cholesterol.
- Diffuse atherosclerosis significantly impacts quality of life and is linked to modifiable risk factors.
- Early detection and aggressive risk factor intervention are warranted.
Background:
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.
Methods:
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.
Results:
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.
Conclusions:
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.