血清中缺氧诱导因子1和脂蛋白相关磷脂酶2与患者冠状动脉粥样硬化斑块形态特征及心血管事件的关系

目的探讨冠心病患者血清中缺氧诱导因子1(HIF-1α)和脂蛋白相关磷脂酶2(PLA2)水平与患者动脉粥样硬化斑块形态特质及心血管事件的关系。方法以本院2012年9月-2015年9月收治的86例冠心病患者为研究对象,采用酶联免疫吸附法检测患者血清中HIF-1α和PLA2水平,采用冠脉CT分析患者冠脉斑块的形态,探讨不同HIF-1α和PLA2水平患者动脉斑块类型和冠脉病变程度的关系,并采用Logistic回归分析探讨血清中HIF-1α和PLA2水平与患者心血管事件风险的关系。结果 HIF-1α高水平组、PLA2高水平组患者软斑块均明显低于对应低水平组,而钙化斑块明显高于低水平。HIF-1α高水平组、PLA2高水平组患者单支病变均明显低于对应低水平,多支病变多于高水平,完全闭塞明显高于低水平组,轻度闭塞低于低水平组,差异均有统计学意义(P0.05)。HIF-1α、PLA2、软斑块、重度冠脉狭窄、多支冠脉病变是患者心血管事件的独立风险因素(P0.05)。结论冠心病患者血清中HIF-1α和PLA2水平与患者冠脉病变程度和心血管事件密切相关。     

冠状动脉临界病变的诊断及治疗决策

近年来冠状动脉造影广泛应用于可疑或已确诊的冠心病患者,使得冠状动脉临界病变的检出越来越多,给予临界病变患者何种治疗即血运重建治疗还是药物治疗尚无统一定论。冠心病患者依据冠脉造影下冠脉狭窄程度决定是否予以血运重建术,但临界病变患者的预后除与冠脉狭窄程度相关外,与病变的性质相关性更大,而冠脉造影对临界病变提供的信息有限,使其在此类患者治疗决策中的应用受限。加强对冠脉病变斑块性质特点的认识与研究,综合评价冠脉临界病变,对心血管事件的防治具有重要意义。本文对冠脉临界病变的几种主要微创检测方法予以综述。     

血流储备分数指导下的介入治疗对不稳定性心绞痛患者近期预后的影响

目的分析血流储备分数(FFR)与冠状动脉造影判断的冠状动脉狭窄程度的关系及其指导下的介入治疗对不稳定性心绞痛患者近期预后的影响。方法连续入选2012年9月20日~2013年12月31日在北京大学人民医院行冠状动脉造影显示为临界病变(直径狭窄程度50%~70%)、术中同时行FFR检查的不稳定性心绞痛患者,共54例64支病变血管,与同时期行冠状动脉造影的不稳定性心绞痛临界病变病例进行1:3匹配,FFR0.80时行药物治疗,FFR≤0.80时行介入治疗,分析术前FFR数值与冠状动脉狭窄程度的关系,并分析入院时急性冠状动脉事件的全球性注册研究(GRACE)评分和出院时GRACE评分以及随访期间的主要心血管不良事件(包括心绞痛无缓解、再次靶血管血运重建、非致死性心肌梗死和心源性死亡)。结果对于冠状动脉狭窄程度为临界病变的不稳定性心绞痛患者,术前FFR数值与冠状动脉狭窄程度无相关性(P=0.108,相关系数=-0.158),行FFR检查的患者较冠状动脉造影指导的对照组随访期间总的主要心血管不良事件明显降低(P=0.000),主要是心绞痛无缓解和再次靶血管血运重建的发生率降低(P值分别为0.002和0.026),行FFR检查的两组患者入院时,GRACE评分无统计学差异(P=0.425),FFR≤0.80行介入治疗的患者较FFR0.80的患者出院时,GRACE评分降低(P=0.029)。结论术前FFR数值与不稳定性心绞痛患者冠状动脉的狭窄程度无相关性,FFR检查指导介入治疗可以降低术后的主要心血管不良事件发生率和出院时GRACE评分。     

阿托伐他汀片对冠状动脉粥样硬化斑块的作用观察

目的观察阿托伐他汀钙片对冠状动脉粥样硬化斑块的作用。方法在2010年10月至2011年4月有冠心病不稳定型心绞痛的患者行冠脉造影或冠脉双源CT检查符合1支或多支冠脉血管狭窄程度达到50-70%,入选48例患者,根据是否规律应用阿托伐他汀钙片使低密度脂蛋白降至2.0mmol/L以下分为对照组(24例)和观察组(24例),1年-1年半后再次复查冠脉造影或冠脉双源CT,分析这些患者的临床及冠状动脉病变变化特点。结果与对照组相比,阿托伐他汀钙片组冠状动脉粥样硬化斑块回退率和斑块无进展率明显增高,主要不良心血管事件发生率降低,差异具有统计学意义。结论阿托伐他汀钙片可使冠状动脉粥样硬化患者的斑块回退,管腔扩大,远期心脏不良事件发生率降低,疗效肯定,值得推广。     

氯吡格雷联合阿司匹林对ACS患者行PCI术的疗效及抗感染作用

目的 观察双倍剂量氯吡格雷联合阿司匹林在行经皮冠状动脉介入治疗(PCI)急性冠脉综合征(ACS)患者中的疗效和抗感染作用.方法 对于ACS患者PCI术后血栓并发症高危患者168例,随机分为3组,观察组使用双倍负荷量和双倍维持量(共2周)的氯吡格雷,3组患者术前每天均服用阿司匹林100 mg(＞1周),手术当天服用300 mg,术后给予100 mg维持;术后给予药物治疗,并观察术后30 d内心血管死亡、心肌梗死、心绞痛、脑卒中、休克等心血管事件和出血并发症的发生.结果 30 d内A组仪发生心血管事件2例(3.6％),为复发性缺血症和心肌梗死;与B、C组相比效果最著,差异有统计学意义(P＜0.05).结论 对于ACS患者PCI术后血栓并发症高危患者给予双倍剂量的氯吡格雷后,心血管事件和出血发生较少,术后无感染病例发生.     

女性胸痛患者中冠脉病变及近期预后的多因素分析

目的探讨女性胸痛患者冠脉病变及近期心血管事件与心血管危险因子、颈动脉硬化积分的关系。方法回顾分析因胸痛拟诊冠心病(CAD)入院的309例女性患者。记录年龄、高血压、糖尿病病史,进行颈动脉彩超检查、冠脉造影,记录入院时收缩压、血脂、空腹血糖水平。并对所有患者随访(14±8)月(6-22月)。分析女性胸痛患者罹患冠心病及冠脉病变范围的相关因素,胸痛患者近期心血管事件的相关性因素。结果年龄、入院时收缩压水平、动脉硬化斑块积分、入院时空腹血糖水平、甘油三脂水平,冠心病组高于非冠心病组;高密度脂蛋白水平冠心病组低于非冠心病组。冠心病组老年患者高血压病、糖尿病、空腹血糖异常比例高于非冠心病组。多支病变组老年患者糖尿病或空腹血糖异常的比例高于单支病变组。年龄、颈动脉硬化斑块积分、入院时空腹血糖水平与冠脉病变范围正相关。患者的年龄、颈动脉硬化及积分、HDL异常是近期心血管事件独立预测因子。结论女性胸痛患者中,多种心血管危险因素和颈动脉硬化积分与冠脉病变及病变范围相关。患者的年龄、颈动脉硬化及积分、HDL异常是近期心血管事件独立预测因子。     

踝臂指数对急性冠脉综合征患者预后的预测价值

目的 观察踝臂指数(ankle brachial index,ABI)与急性冠脉综合征患者预后之间的关系.方法 对121例急性冠脉综合征(ACS)患者测定ABI值,根据ABI测定结果为依据将121例患者分为正常ABI组(1.4＜ABI>0.9)与低ABI组(ABI≤0.9),观察两组患者住院期间及出院后6月内心血管不良事件发生情况.结果 低ABI组心血管事件(严重心律失常、顽固性心绞痛、再发心肌梗死、充血性心衰、心源性休克和心源性死亡)发生率高于正常ABI组,相比较有统计学差异(P＜0.05).结论 ABI≤0.9对急性冠脉综合征患者的预后有预测价值,低ABI的急性冠脉综合征患者主要心血管不良事件发生率高,预后较差.ABI作为下肢外周动脉疾病的无创检测手段,可以作为急性冠脉综合征患者预后的判断指标.     

脑钠肽、超敏C-反应蛋白、超敏肌钙蛋白Ⅰ水平对急性冠脉综合征患者病变严重程度及预后评估的临床意义

目的探讨脑钠肽(BNP)、超敏C-反应蛋白(hs-CRP)、超敏肌钙蛋白I(TnIU1tr)对急性冠脉综合征患者病变严重程度及预后的影响。方法选取120例急性冠脉综合征患者作为研究对象,其中不稳定型心绞痛(UA)42例、ST段抬高心肌梗死(STEMI)47例、无ST段抬高心肌梗死(NSTEMI)31例,另选取同期于本院体检的40例健康志愿者为对照组,检测各组对象的BNP、hs-CRP、TnIU1tr水平,并根据病变支数及是否发生心血管事件分组比较BNP、hs-CRP、TnIU1tr水平。结果各组患者的BNP、hs-CRP及TnIU1tr水平高于对照组,差异均有统计学意义(P0.05);UA组、NSTEMI组、STEMI组的BNP、hs-CRP及TnIU1tr水平依次升高;单支病变组、双支病变组、3支病变组的BNP、hs-CRP及TnIU1tr水平依次升高;发生心血管事件组的BNP、hs-CRP及TnIU1tr水平高于未发生心血管事件组,上述差异均有统计学意义(P0.05)。结论 BNP、hs-CRP及TnIU1tr水平与急性冠脉综合征病变严重程度密切相关,并具有评估预后的价值。     

糖耐量异常对急性心肌梗死患者预后的预测价值

目的观察心肌梗死后新检测出糖代谢异常与患者预后的相关关系。方法106例既往无糖尿病病史,入院血糖<11.1 mmol/L的心肌梗死的患者行口服葡萄糖耐量实验(OGTT),平均随访6个月观察患者主要心血管事件(心血管病因死亡,非致命性再梗,脑卒中以及严重心力衰竭)的发生率。结果42例(39.6%)患者糖耐量正常,64例(60.4%)患者糖耐量异常。期间有6例患者因心血管病因死亡,均为糖耐量异常组患者。糖耐量正常组中出现4(9.5%)次终点事件,而糖耐量异常组中出现22(34.4%)次终点事件,2组比较差异有统计学意义(P<0.01)。结论糖耐量异常是预测心肌梗死后远期心血管事件的强有力危险因素。因此早期识别有助于对高危患者进行二级预防。     

心肌血流储备分数及血管内超声在冠脉复杂病变介入治疗中的应用研究

目的探讨心肌血流储备分数(FFR)及血管内超声(IVUS)在冠脉复杂病变介入治疗中的应用。方法将60例冠脉造影术提示冠脉复杂病变患者分为对照组(以CAG指导)20例,FFR组(在CAG加FFR指导)15例,IVUS组(在CAG加IVUS指导)25例。主要终点事件为1年内主要心脏不良事件(MACE)情况,包括死亡、心肌梗死及再次血运重建,并比较三组手术中支架情况、手术时间、造影剂用量、住院费用。结果 1年内对照组与IVUS组及FFR组在再狭窄率、复发心绞痛、再次PCI及总MACE事件方面有统计学差异(P<0.05);但晚期血栓、复发心肌梗死及冠脉搭桥术上无统计学差异(P>0.05)。三组在支架的直径、数量、造影剂用量及住院费用上均有统计学差异(P<0.05);而在支架长度、手术时间方面均无统计学差异(P>0.05)。结论对于复杂冠脉病变,IVUS及FFR是建立在CAG基础上积极可靠的技术,能弥补CAG的不足,为术者提供更多更准确的信息,准确判断冠脉介入的必要性,减少不良心血管事件,为患者带来更好的预后。     

Gender differences for associations between circulating levels of metals and coronary risk in the elderly

Several studies have pointed out associations between various metals and cardiovascular disease. Since cardiovascular disease prevalence is different between males and females, we investigated whether circulating levels of metals related differently to coronary risk in men and women. In the Prospective Investigation of the Vasculature in Uppsala Seniors (PIVUS) study, coronary risk was assessed by the Framingham Risk Score together with circulating blood levels of 11 different trace and heavy metals in 1016 subjects aged 70 years. Circulating levels of cadmium, copper and manganese were significantly higher in women than in men, while mercury, zinc and lead were significantly lower following adjustment for kidney function (measured by glomerular filtration rate, GFR). No significant differences between women and men were seen regarding levels of aluminium, molybdenum, cobalt, chromium and nickel. When all 11 metals were entered as independent variables together with GFR in multiple models in the Framingham Risk Score as the dependent variable, cadmium was the major determinant of the Framingham Risk Score in women (p<0.0001, followed by zinc p=0.03), while copper was the major determinant of the Framingham Risk Score in men (p<0.0001, followed by inverse relations vs. aluminium p=0.01 and nickel p=0.01). There are gender differences in levels of metals and also regarding the association between metals and coronary risk, with cadmium levels being most important for women and copper levels for men in this elderly population.     

新危险因素在预测中年男性缺血性心血管病20年发病风险中的作用

目的 评价Framingham冠心病预测模型(Framingham模型)与国人缺血性心血管病发病风险预测模型(国人模型)在预测上海市中年男性缺血性心血管病20年发病中的准确性,及预测模型引入新危险因素后的潜在附加值。方法 在1992年参加"中国11省市队列人群心血管病发病前瞻性研究(CMCS) "基线时无冠心病与脑卒中的840例上海市男性作为随访队列(CMCS上海队列),每年随访一次,记录本年度发生的心血管病事件和死亡。2007年复查基线危险因素,并增加测量新的危险因素。采用C-statistic与Hosmer-Lemeshow χ²检验比较Framingham模型及国人模型的预测能力,并以国人模型为基本预测模型,将新危险因素依次独立添加至基本模型。通过计算受试者工作特征曲线下面积(AUC)、重新分类净改善(NRI)指数和综合判别改善(IDI)指数评价新危险因素的预测能力。结果 截止2014年12月,CMCS上海队列平均随访22.3年,在可供分析的17 617人年中,共发生冠心病事件(心肌梗死或/和冠心病死亡)24例和缺血性脑卒中45例。国人模型预测上海市中年男性20年缺血性心血管病发病风险表现良好, 其中Framingham模型:AUC=0.657 6(95%CI:0.594 2~0.724 0),国人模型:AUC=0.726 5(95%CI:0.664 3~0.788 7),国人模型优于Framingham模型,AUC增量为0.068 9(95%CI:0.019 6~0.117 1),P=0.006。以国人模型为基本模型,未发现新危险因素可显著改善模型的再分类能力。"高敏C反应蛋白"是唯一导致NRI显著增加的危险因素。2007年风险评分可显著改善IDI,但净变化很小。结论 国人模型具有良好的预测上海市中年男性20年缺血性心血管病发病风险能力,增加"高敏C反应蛋白"因素可小幅度改进风险预测,但对改变临床风险的重新分类或鉴别策略收效甚微。     

The effect of including cystatin C or creatinine in a cardiovascular risk model for asymptomatic individuals: the multi-ethnic study of atherosclerosis

The authors studied the incremental value of adding serum cystatin C or creatinine to the Framingham risk score variables (FRSVs) for the prediction of incident cardiovascular disease (CVD) among 6,653 adults without clinical CVD utilizing the Multi-Ethnic Study of Atherosclerosis (2000-2008). CVD events included coronary heart disease, heart failure, stroke, and peripheral arterial disease. Variables were transformed to yield optimal prediction of 6-year CVD events in sex-stratified models with FRSVs alone, FRSVs + cystatin C, and FRSVs + creatinine. Risk prediction in the 3 models was assessed by using the C statistic, and net reclassification improvement was calculated. The mean ages were 61.9 and 64.6 years for individuals with and without diabetes, respectively. After 6 years of follow-up, 447 (7.2%) CVD events occurred. In the total cohort, no significant change in the C statistic was noted with FRSVs + cystatin C and FRSVs + creatinine compared with FRSVs alone, and net reclassification improvement for CVD risk was extremely small and not significant with the addition of cystatin C or creatinine to FRSVs. Similar findings were noted after stratifying by baseline presence of diabetes. In conclusion, the addition of cystatin C or serum creatinine to FRSVs does not improve CVD risk prediction among adults without clinical CVD.     

平板运动试验可疑阳性患者的冠状动脉CT及冠状动脉造影结果的相关性研究

目的 探讨平板运动试验(TET)可疑阳性患者的冠状动脉造影(CAG)结果的特点.方法 2006年1月至2007年12月因胸痛住院的36例患者在人院行TET后均诊断为可疑阳性,同时在2周内行CAG检查和冠状动脉CT成像(CTA),并将斑块分为非钙化和钙化斑块.结果 36例患者中,23例经CAG证实为冠心病(阳性),13例冠状动脉无病变(阴性).23例冠心病患者中单支病变9例,双支病变5例,三支病变9例.23例TET可疑阳性冠心病患者CTA共检测52个斑块,其中非钙化斑块29个,钙化斑块23个.结论 TET在冠心病的诊断中因其方法简单、经济、无创,目前仍不失为一项重要检查方法.同时冠心病患者的斑块性质与TET可疑阳性具有相关性.     

Coronary heart disease risk prediction in the Atherosclerosis Risk in Communities (ARIC) study

Risk prediction functions for incident coronary heart disease (CHD) were estimated using data from the Atherosclerosis Risk in Communities (ARIC) Study, a prospective study of CHD in 15,792 persons recruited in 1987-1989 from four U.S. communities, with follow-up through 1998. Predictivity of which individuals had incident CHD was assessed by increase in area under ROC curves resulting from adding nontraditional risk factors and markers of subclinical disease to a basic model containing only traditional risk factors. We also assessed the increase in population attributable risk. The additional factors were body mass index; waist-hip ratio; sport activity index; forced expiratory volume; plasma fibrinogen, factor VIII, von Willebrand factor, and Lp(a); heart rate; Keys score; pack-years smoking; and subclinical disease marker carotid intima-media thickness. These factors substantially improved prediction of future CHD for men, less for women, and also increased attributable risks.     

Expert review on coronary calcium

While there is no doubt that high risk patients (those with >20% ten year risk of future cardiovascular event) need more aggressive preventive therapy, a majority of cardiovascular events occur in individuals at intermediate risk (10%-20% ten year risk). Accurate risk assessment may be helpful in decreasing cardiovascular events through more appropriate targeting of preventive measures. It has been suggested that traditional risk assessment may be refined with the selective use of coronary artery calcium (CAC) or other methods of subclinical atherosclerosis measurement. Coronary calcification is a marker of atherosclerosis that can be quantified with the use of cardiac CT and it is proportional to the extent and severity of atherosclerotic disease. The published studies demonstrate a high sensitivity of CAC for the presence of coronary artery disease but a lower specificity for obstructive CAD depending on the magnitude of the CAC. Several large clinical trials found clear, incremental predictive value of CAC over the Framingham risk score when used in asymptomatic patients. Based on multiple observational studies, patients with increased plaque burdens (increased CAC) are approximately ten times more likely to suffer a cardiac event over the next 3-5 years. Coronary calcium scores have outperformed conventional risk factors, highly sensitive C-reactive protein (CRP) and carotid intima media thickness (IMT) as a predictor of cardiovascular events. The relevant prognostic information obtained may be useful to initiate or intensify appropriate treatment strategies to slow the progression of atherosclerotic vascular disease. Current data suggests intermediate risk patients may benefit most from further risk stratification with cardiac CT, as CAC testing is effective at identifying increased risk and in motivating effective behavioral changes. This article reviews information pertaining to the clinical use of CAC for assessing coronary atherosclerosis as a useful predictor of coronary artery disease (CAD) in certain population of patients.     

National Cholesterol Education Program risk assessment and potential for risk misclassification

BACKGROUND: The National Cholesterol Education Program Adult Treatment Panel report from 2001 (ATP III) recommends clinicians calculate 10-year coronary risk using multivariable methods only for adults with 2 or more risk factors. We aimed to determine who would be falsely classified as low risk using this approach. METHODS: We studied 4097 adults aged 20 to 79 years without diagnosed cardiovascular disease or diabetes from the National Health and Nutrition Examination Survey from 1999 to 2002. We determined the proportion with fewer than 2 risk factors who nonetheless had estimated 10-year risk of cardiac death or myocardial infarction > or =10% using multivariable methods. RESULTS: Among persons with fewer than 2 risk factors, 5.3% (95% confidence interval 4.7 to 6.1%), had a 10-year risk > or =10% using the Framingham Risk Score and would be misclassified using the risk factor counting method (this corresponds to approximately 5,640,000 U.S. adults). Compared to individuals whose classification was unchanged, those misclassified as low risk were older (P<0.001) and more likely male (85.5% vs. 41.2%, P<0.001). CONCLUSIONS: Relying on the ATP III risk factor counting method rather than determining risk using multivariable methods in all patients resulted in misclassifiying as low risk over 5 million adults with at least moderately high risk of coronary heart disease, most of whom are middle-aged and older men.     

冠心病患者颈动脉斑块与冠状动脉斑块的相关性及外周血巨噬细胞集落刺激因子、C反应蛋白与斑块稳定性的关系

目的 探讨颈动脉斑块与冠状动脉斑块的相关性及外周血巨噬细胞集落刺激因子(M-SCF)、C反应蛋白(CRP)水平与斑块稳定性的关系.方法 将400例患者根据冠状动脉造影结果分为非冠心病(NCHD)组93例、急性冠状动脉综合征(ACS)组202例、稳定型心绞痛(SAP)组105例.根据冠状动脉造影斑块的形态特征将冠状动脉斑块分为Ⅰ、Ⅱ、Ⅲ型.根据超声特点将颈动脉斑块分为易损型和稳定型,比较ACS组、SAP组与NCHD组患者斑块的类型及外周血M-SCF、CRP水平的变化.结果 ACS组冠状动脉斑块主要为Ⅱ型,占78.7%(159/202),颈动脉斑块主要为易损型,占69.3%(140/202).而SAP组冠状动脉斑块Ⅰ、Ⅱ、Ⅲ型分别占40.0%(42/105)、30.5%(32/105)和29.5%(31/105),颈动脉斑块主要为稳定型.ACS组外周血M-SCF、CRP水平显著高于SAP组和NCHD组(P＜0.05),SAP组与NCHD组比较差异无统计学意义(P＞0.05).冠状动脉斑块Ⅱ型患者较Ⅰ、Ⅲ型患者M-SCF、CRP水平明显升高(P＜0.05);颈动脉斑块易损型患者M-SCF、CRP水平较稳定型患者明显升高(P＜0.05).结论 冠状动脉斑块与颈动脉斑块密切相关.外周血M-SCF、CRP水平和斑块特征与斑块的稳定性有关,对于冠状动脉事件有一定的预示作用.     

State of the art coronary heart disease risk estimations based on the Framingham heart study

The aim was to review the most interesting articles dealing with estimations of an individual's absolute coronary heart disease risk based on the Framingham heart study. Besides the Framingham coronary heart disease risk functions, results of validation studies of these Framingham risk functions are discussed. In general, the Framingham risk functions overestimated an individual's absolute risk in external (non-Framingham) populations with a lower occurrence of coronary heart disease compared with the Framingham population, and underestimated it in populations with a higher occurrence of coronary heart disease. Even if the calibration accuracy of the Framingham risk functions were not satisfying, the Framingham risk functions were able to rank individuals according to risk from low-risk to high-risk groups, with the discrimination ability of 60% and more.     

Framingham Risk Scores and Anthropometric Measurements in Predicting Cardiovascular Risks among Malay Men

Framingham Risk Scores is an established method to predict an individual's 10-year risk for coronary heart disease (CHD). It provides a more precise delineation of risk which might lead to appropriate selection of therapy and opportunities for patient education and motivation. A Healthy Lifestyle Project was initiated to decrease the modifiable risk factors for CHD in a worksite in Kuala Lumpur. The participants were Malay men (n=186) working as security guards in a public university. Their mean age was 46.6 + 6.6 years. The majority had secondary education and were married. The participants' 10-year risks based on the Framingham Risk Scores were 55.4%, 39.8% and 4.8% respectively for categories of low (< 10%), intermediate (10 to 20%) and high (>20%) risk. Their Framingham Risk Scores were then correlated with anthropometric measurements such as the Body Mass Index (BMI), waist circumference and waist-hip-ratio (WHR). All the anthropometric measurements had weak but significant correlation with the Framingham Risk Scores (WHR: r=0.26; waist circumference: r=0.23; BMI: r=0.16). In conclusion, 44.6% of our participants had more than 10% risk in developing CHD in the coming ten years. Hence, they are suitable target candidates for the promotion of a healthy lifestyle such as smoking cessation, weight control, healthy dietary patterns and increased physical activities. Indicators of abdominal obesity like WHR or waist circumference may be used to complement the Framingham Risk Scores for the prediction of CHD risk in this population.