Coronary risk factors and extent of angiographically proven coronary artery stenoses (author's transl)]

In 196 patients with angina pectoris selective coronary angiography was performed, and the extent of angiographically proven coronary artery stenoses was described by means of a coronary score. A significant correlation between the degree of atherosclerotic lesions on the one hand and hypertriglyceridemia, hypercholesterolemia as well as smoking habits on the other hand was detected. No correlation between other risk factors, such as hypertension, diabetes mellitus, hyperuricemia and obesity, and the coronary score was observed.     

无症状性冠状动脉内膜病变与冠心病危险因素关系的探讨

目的探讨无症状性冠状动脉内膜病变的发生频率及其与高血压、糖尿病和低密度脂蛋白胆固醇(LDL-C)的关系。方法应用冠状动脉血管内视镜技术对2003-06—2004-09日本医科大学附属千叶北总病院收治的120例陈旧性心肌梗死和稳定型心绞痛患者的非罪犯血管进行观察其有无黄色斑块、斑块破裂和(或)血栓形成等内膜病变,分别探讨它们与高血压、糖尿病和LDL-C的关系。结果120例患者(155支)非罪犯血管内,观察到内膜病变者80例(66·67%),其中合并高血压和高LDL-C血症者明显高于非内膜病变组(P<0·005),合并糖尿病者也高于非内膜病变组(P<0·05);观察到黄色斑块者30例(25·00%),其中合并高LDL-C血症者明显高于非内膜病变组(P<0·005);观察到斑块破裂和(或)伴有血栓形成等复杂斑块者50例(41·66%),其中合并高血压者明显高于非内膜病变组(P<0·005),合并高胆固醇血症者也高于非内膜病变组(P<0·01)。结论糖尿病、高血压及高LDL-C血症等是无症状性粥样斑块形成、不稳定甚至破裂的基础,所以,对糖尿病、高血压及血脂积极控制和治疗对ACS的预防是极其重要的。     

Blacks in the Coronary Artery Surgery Study: risk factors and coronary artery disease

In this paper we examine the relationship between risk factors and angiographically determined coronary artery disease for blacks and whites enrolled in the Coronary Artery Surgery Study (CASS). Analysis of data from the CASS registry indicated that blacks had a higher incidence of hypertension and current cigarette smoking than did whites in CASS and that chest pain was the major reason that both blacks and whites underwent coronary angiography for suspected or proven coronary disease. The CASS data also showed that, despite high levels of risk factors and chest pain, blacks had minimal or absent coronary disease. The results of this study raise several questions. First, to what extent are blacks in CASS representative of blacks in the general population and blacks undergoing coronary angiography? Additionally, are risk factors for coronary artery disease different for blacks than for whites? And finally, how does the physician effectively treat the black patient with high levels of risk factors and minimal coronary disease?     

Sudden coronary death in Glasgow: the severity and distribution of chronic coronary atherosclerotic stenoses.

A detailed analysis of the extent of coronary artery atherosclerosis was made in 92 white subjects (66 men and 26 women) who died suddenly from ischaemic heart disease. Stenoses resulting in loss of greater than or equal to 75% of luminal cross sectional area (significant stenosis) were found in 90 subjects and these were more extensive in the proximal coronary tree than in the distal. Thirty nine per cent had triple vessel disease, 37% had double vessel disease, and 23% had single vessel disease. In addition one man had an isolated significant stenosis affecting the left main coronary artery. The frequency of significant stenoses in the left main coronary artery was greater in men than in women. The arteries that were least affected were the distal branches of the right coronary artery. A notable feature was the widespread nature of the coronary atherosclerosis: only 26 of the total of 1840 segments of coronary artery examined in the 92 victims could be described as having a normal intima (less than or equal to 10% loss of the area within the internal elastic lamina).     

Coronary calcification, coronary disease risk factors, C-reactive protein, and atherosclerotic cardiovascular disease events: the St. Francis Heart Study

OBJECTIVES: The purpose of this study was to determine the prognostic accuracy of electron beam computed tomographic (CT) scanning of the coronary arteries and the relationship of coronary calcification to standard coronary disease risk factors and C-reactive protein (CRP) in the prediction of atherosclerotic cardiovascular disease (ASCVD) events in apparently healthy middle-age persons. BACKGROUND: As a screening test for coronary artery disease (CAD), electron beam CT scanning remains controversial. METHODS: In a prospective, population-based study, 4,903 asymptomatic persons age 50 to 70 years underwent electron beam CT scanning of the coronary arteries. RESULTS: At 4.3 years, follow-up was available in 4,613 participants (94%), and 119 had sustained at least one ASCVD event. Subjects with ASCVD events had higher baseline coronary calcium scores (median [interquartile range], Agatston method) than those without events: 384 (127, 800) versus 10 (0, 86) (p < 0.0001). For coronary calcium score threshold > or = 100 versus < 100, relative risk (95% confidence interval) was 9.6 (6.7 to 13.9) for all ASCVD events, 11.1 (7.3 to 16.7) for all CAD events, and 9.2 (4.9 to 17.3) for non-fatal myocardial infarction and death. The coronary calcium score predicted CAD events independently of standard risk factors and CRP (p = 0.004), was superior to the Framingham risk index in the prediction of events (area under the receiver-operating characteristic curve of 0.79 +/- 0.03 vs. 0.69 +/- 0.03, p = 0.0006), and enhanced stratification of those falling into the Framingham categories of low, intermediate, and high risk (p < 0.0001). CONCLUSIONS: The electron beam CT coronary calcium score predicts CAD events independent of standard risk factors, more accurately than standard risk factors and CRP, and refines Framingham risk stratification.     

早发冠心病患者冠状动脉病变特点及危险因素分析

目的 探讨早发冠心病患者冠状动脉病变特点及危险因素.方法 入选我院2012年6月至2014年4月经冠状动脉造影诊断为冠心病的患者279例,根据男性年龄≤55岁、女性年龄≤65岁分为早发冠心病组和非早发冠心病组.统计患者入院基本临床资料.所有患者均检测空腹血糖（FPG）、总胆固醇（TC）、甘油三酯（TG）、高密度脂蛋白胆固醇（HDL-C）和低密度脂蛋白胆固醇（LDL-C）.根据冠状动脉狭窄直径≥50％累及左前降支（LAD）、左回旋支（LCX）、右冠状动脉（RCA）或左主干（LM）分为单支、双支（累及左主干为双支病变）及三支病变组.根据Gensini积分标准对每位患者冠状动脉病变进行评分.结果 早发冠心病组男性比例、吸烟比例、存在早发冠心病家族史的比例、TG水平显著高于非早发冠心病组（P＜0.05）.与非早发冠心病组相比,早发冠心病组患者以单支病变为主,二者在受累冠状动脉部位上并无差别.非早发冠心病组患者平均冠状动脉病变支数、平均Gensini积分高于早发冠心病组（1.97±0.82比1.66±0.93,P=0.003;8.72±6.21比48.65±8.90,P=0.000）.多因素Logistic回归分析显示,男性（95％CI：2.342～10.420,P=0.000）、吸烟（95％CI：9.468～31.220,P=0.000）、早发冠心病家族史（95％CI：8.120～23.480,P=0.001）、TG（95％CI：1.224～5.465,P=0.001）是早发冠心病患者独立危险因素.结论 早发冠心病患者冠状动脉病变特点是以单支病变为主.男性、吸烟、早发冠心病家族史、TG是早发冠心病患者的独立危险因素.积极戒烟、降低TG能够降低早发冠心病的发病率.     

Results of coronary artery bypass surgery. Surgical mortality, survival and follow-up functional state. Multivariate discriminant analysis of relative risk factors

Clinical results of coronary artery bypass surgery, have been evaluated by analyzing operative mortality, late survival, late functional results and their related risk factors. Four hundred and thirty-seven consecutive patients who underwent coronary artery bypass surgery between January, 1979, and December, 1983, were the clinical material of this study. The gender of patients was male in 89% of the cases; age ranged from 34 to 78 years with a mean of 54.8 +/- 8.2 (SD). Patients with combined surgical procedures were excluded. Follow-up averaged 55.7 months; 404 survivors have been contacted (97% of the total study population, if operative and late deaths are added); 218 patients underwent a control exercise test; postoperative employment status was determined for 242 individuals. The operative mortality was 5.49% (24 patients). Death was due to cardiac causes in 75% of the cases. The overall actuarial survival rate was 85 +/- 1.9% after 5 years and 83.4 +/- 2.2% after 7 years. When non-cardiac related deaths were excluded the actuarial rates were 88 +/- 1.7% and 87.2 +/- 1.9% after 5 and 7 years respectively. Actuarial freedom from all ischemic events (cardiac related death, late myocardial infarction or recurrence of angina) was 66.1 after five years, and was 70.2% if operative deaths were excluded. Actuarial freedom from recurrence of angina for patients alive at follow-up was 78.7% after five years, actuarial freedom from myocardial infarction was 93.5%. The mortality hazard showed a diphasic response, being higher perioperatively and constant in the following 5 years of follow-up. All ischemic events, both singularly and together, showed an accelerated rate of occurrence at the first and after the fifth postoperative year, the slope of the curve being quite flat during the 1 to 5 year interval. The control exercise test was negative for 62.8% of the patients, positive for 33.5% and undeterminable in 3.7%. Employment status was postoperatively unaffected in 49.6% of the cases, while 27.3% of the patients retired: the remaining individuals had already retired before surgery. Statistical analysis (stepwise logistic regression) identified age (p = 0.002) and cross-clamp time (p = 0.016) as significant risk factors of operative mortality. The ejection fraction showed a value close to statistical significance (p = 0.06).(ABSTRACT TRUNCATED AT 400 WORDS)     

Fatty liver hepatitis (steatohepatitis) and obesity: an autopsy study with analysis of risk factors

Steatohepatitis (fatty liver hepatitis), histologically identical to alcoholic disease, occurs in some obese patients after jejunoileal bypass. A similar lesion occurs rarely in obese patients without bypass surgery, but the risk factors are poorly understood. Hepatic steatosis, steatohepatitis and fibrosis were sought in 351 apparently nonalcoholic patients at autopsy and various risk factors were evaluated. Incidence of steatosis and steatohepatitis correlated with the degree of obesity. Steatohepatitis was found in 18.5% of markedly obese patients and 2.7% of lean patients. Additional risk factors for steatohepatitis were type II diabetes, weight loss in the preterminal period shortly before death and intravenous glucose therapy in the last week of life. Severe fibrosis was found in 13.8% of markedly obese patients and in 6.6% of lean patients; this difference was largely explained by the higher prevalence of diabetes in obese groups. The risk factors defined in this study are known to be associated with abnormalities of free fatty acid metabolism. Obesity, type II diabetes and intravenous glucose therapy are associated with hyperinsulinemia, which may inhibit fatty acid oxidation. Obesity and weight loss increase the presentation of fatty acids to the liver. Similar metabolic changes may occur in obese patients after jejunoileal bypass surgery. Thus this study supports the hypothesis that fatty acids have a role in the hepatocellular necrosis found in some obese individuals.     

Coronary risk factors and incidence of coronary death in relation to physical fitness. Seven-year follow-up study of middle-aged and elderly men

Physical fitness was assessed in relation to a near maximalbicycle exercise test in two populations; population 1: 122middle aged and elderly cross-country skiers with a documentedvery high physical performance, and population 2: 2014 apparentlyhealthy men 40–59 years of age. All were without knownor suspected heart disease at the baseline study. A number ofso-called coronary risk factors were studied simultaneously.The total incidence of coronary heart disease (CHD) events werenoted as was the total 7 year incidence of death from CHD amongmen from population 2. By subdividing the latter in quartilesof physical fitness within each 5 year age group—and studyinglevels of coronary risk factors and CHD deaths within these16 subgroups—the following findings were made: All coronaryrisk factors were favourably and strongly associated with highphysical fitness and vice versa in consistent way. Death frommyocardial infarction and sudden, unexpected death followedthe same pattern in an inverse way. The skiers as a group closelyfollowed the most fit men from population 2 in all respects.Thus we have noted a strong, graded, positive association betweenphysical fitness and a number of coronary risk factors, andan inverse relationship between high physical fitness and therisk of dying from CHD. These findings hold true for a periodof 7 years among middle aged men free fromknown orsuspectedheart disease.     

Sudden coronary death in Glasgow: nature and frequency of acute coronary lesions.

A detailed pathological study of the coronary arteries was carried out on 130 random white subjects (91 male and 39 female) who died suddenly in the Glasgow area. In 30 there was a clearly defined cause of death that was not due to ischaemic heart disease. In eight subjects the cause of death was in doubt. Ninety two of the 130 showed coronary stenosis resulting in a loss of more than 75% of coronary artery cross sectional area and/or acute coronary events with no other cause of death. Of these 92 subjects considered to have died suddenly of ischaemic heart disease, 64% showed plaque rupture and thrombosis which occurred at sites of previous high grades of stenosis. Twenty two subjects had intraluminal thrombosis unrelated to plaque fissuring. Thirty eight (41%) showed histological evidence of recent myocardial necrosis; acute coronary events occurred in 34 of these. There was no correlation between the duration of symptoms before death and the occurrence of acute coronary events. Acute coronary events, mainly in the form of plaque rupture, are a common finding in sudden coronary death when a careful study is made of the whole coronary arterial tree.     

Occurrence of coronary ostial stenosis in a necropsy series of myocardial infarction, sudden death, and violent death.

A postmortem coronary angiography technique employing aortic injection of contrast medium and double contrast visualization of the aortic bulb and large epicardial coronary trunks was applied to the study of coronary ostia in a series of 124 deaths from acute myocardial infarction and a series of 89 sudden deaths without recent infarction and 42 violent deaths. A stenosis of 50 per cent or more of the lumen was found in the right ostium in 45 per cent and in the left ostium in 8 per cent of infarct cases. The corresponding figures in sudden deaths were 37 per cent on the right and 4.5 per cent on the left side, and in violent deaths 7 per cent in the right ostium and none in the left. Most ostial stenoses were caused by coronary atherosclerosis. In 9 patients, two with a recent infarct and 7 sudden deaths, an ostial stenosis was the only stenosed site in the coronary arterial tree. Of theses 9 patients, 7 were known to have suffered from symptomatic heart disease during life, chest pain on effort and arrhythmias being the most common complaint.     

Multivariate discriminant analysis of risk factors for operative mortality following isolated coronary artery bypass graft. Loyola University Medical Center experience, 1970 to 1984

The Loyola Open-Heart Registry is a fully operational database that contains detailed data on approximately 9,000 patients who have undergone coronary bypass or cardiac valve replacement from January 1970 to December 1984. We analyzed the registry data using multivariate discriminant analysis to identify and quantitate those factors that might predict operative mortality (OM) for patients undergoing coronary artery bypass grafts at Loyola University Medical Center: Operative mortality was defined as death within 30 days following surgery. A total of 50 clinical and angiographic variables were analyzed for possible univariate association with operative mortality. Twenty-two variables were found to have significant univariate association with OM, and these 22 variables were subjected to multivariate discriminant analysis. For patients undergoing isolated, elective coronary artery bypass, the factors found to be predictive of OM are age (greater than 70) (F = 11.57), severe (more than six stenoses) coronary artery disease (F = 5.81), diffuse disease (F = 5.54), positive family history (F = 5.17), and number of coronary arteries bypassed (F = 4.78).     

Occurrence of coronary ostial stenosis in a necropsy series of myocardial infarction, sudden death, and violent death.

A postmortem coronary angiography technique employing aortic injection of contrast medium and double contrast visualization of the aortic bulb and large epicardial coronary trunks was applied to the study of coronary ostia in a series of 124 deaths from acute myocardial infarction and a series of 89 sudden deaths without recent infarction and 42 violent deaths. A stenosis of 50 per cent or more of the lumen was found in the right ostium in 45 per cent and in the left ostium in 8 per cent of infarct cases. The corresponding figures in sudden deaths were 37 per cent on the right and 4.5 per cent on the left side, and in violent deaths 7 per cent in the right ostium and none in the left. Most ostial stenoses were caused by coronary atherosclerosis. In 9 patients, two with a recent infarct and 7 sudden deaths, an ostial stenosis was the only stenosed site in the coronary arterial tree. Of theses 9 patients, 7 were known to have suffered from symptomatic heart disease during life, chest pain on effort and arrhythmias being the most common complaint.     

Inhospital and delayed mortality after upper gastrointestinal bleeding: an analysis of risk factors in a prospective series

Background: Detailed analyses of mortality after upper gastrointestinal (GI) bleeding are lacking. Follow-up rarely extends beyond 30 days.

Aims: Our aim was to analyze in-hospital and delayed 6-months mortality, identifying risk factors.

Methods: This was a prospective study on patients with upper GI bleeding over 36 months. Clinical outcomes were in-hospital and delayed-6 month-mortality.

Results: Four hundred and forty-none patients were included. Overall inpatient mortality was 9.8% but mortality directly related to bleeding was 5.1%. Patients who died presented lower systolic blood pressures, platelet recounts, prothrombin times and lower levels of hemoglobin, calcium, albumin, urea, creatinine and total proteins. Cirrhosis and neoplasms determined a higher in-hospital mortality. Albumin levels were protective, whereas creatinine and an active bleeding were risk factors for in-hospital death in multivariate analysis. Up to 12.6% of patients discharged died in the first 6 months. Neoplasms, chronic kidney disease, coronary disease and esophageal varices were related to delayed mortality. Coronary disease and neoplasms were independent risk factors for mortality, but albumin levels were protective in multivariate analysis.

Conclusion: Comorbidities were risk factors for delayed mortality, whereas albumin levels were a protective factor for in-hospital and delayed deaths. Six months mortality is proportionately as important as in-hospital mortality. Half of the delayed deaths might be preventable.     

Coronary risk factors and the severity of angiographic coronary artery disease in members of high-risk pedigrees.

Affected members of early coronary pedigrees in Utah are at markedly increased risk for the development of clinical coronary heart disease (CHD). The relationship between the presence of coronary risk factors and the severity of angiographic coronary artery disease (CAD) in 53 members of high-risk Utah pedigrees was examined. Mean angiographic severity scores were higher in familial hypercholesterolemia or familial low high-density lipoprotein cholesterol (HDL-C) pedigrees than in type III hyperlipidemia or familial combined hyperlipidemia pedigrees. One sibling pair with hyperhomocyst(e)inemia had the highest mean angiographic severity scores. Clinical CHD (p less than 0.0001), increasing low-density lipoprotein cholesterol (LDL-C) (p = 0.0107), and decreasing HDL-C (p = 0.0068) were significant predictors of angiographic CAD severity. There appeared to be an interaction between gender and body mass index but not between gender and serum lipids in the prediction of angiographic CAD severity. Results of the present study in members of high-risk Utah pedigrees are consistent with results from other angiographic studies in non-high-risk persons. Of particular interest is the suggested independent predictive value of low HDL-C for angiographic CAD severity in members of high-risk pedigrees.     

Repeated gonorrhea: an analysis of importance and risk factors

This study was designed to assess the epidemiological importance of repeated infections due to Neisseria gonorrhoeae and to analyze variables potentially associated with repeated gonorrhea. The retrospective analysis was of 7,347 patients seen during one year, and the prospective study was of a stratified randomly selected sample of 429 patients. The 492 retrospectively identified repeaters constituted 0.06% of the county population and 6.7% of the clinic population. The 492 repeaters had 21.6% of the cases of gonorrhea reported from the county and 29.4% of the cases reported from the clinic. The repeaters tended to be younger than those without repeated infection (P less than 0.001), male (62%), black (81.7%), and residents of areas of lower socioeconomic status than those who were not repeaters (P less than 0.001). Most repeaters (73.5%) had not graduated from high school. Repeaters did not have significantly greater numbers of sex partners (P greater than 0.05) or greater exposure to prostitutes or clients than those who did not have repeated infections and less frequently had sexual contact while symptomatic. Intensive follow-up of the small number of high-risk repeaters and their contacts could result in a major reduction in the number of reported cases of gonorrhea.