高血压患者发生冠心病的相关危险因素分析

目的探讨高血压患者发生冠心病的相关危险因素。方法选择原发性高血压患者203例,根据冠状动脉造影结果分为单纯高血压组107例和高血压合并冠心病组(冠心病组)96例,分别检测2组尿微量白蛋白与肌酐比值(UACR)、血同型半胱氨酸和高敏C反应蛋白。logistic回归分析原发性高血压患者发生冠心病的危险因素。结果与单纯高血压组比较,冠心病组UACR、同型半胱氨酸、高敏C反应蛋白明显升高[63.62±7.03 vs 40.93±5.92,P=0.035;(19.33±7.04)μmol/Lvs(13.50±6.23)μmol/L,P=0.037;(6.33±0.56)mg/Lvs(3.65±0.47)mg/L,P=0.019]。多因素logistic回归分析显示,UACR、同型半胱氨酸、高敏C反应蛋白为原发性高血压患者发生冠心病的危险因素(OR=2.169,95%CI:1.582~4.350,P=0.035;OR=2.370,95%CI:1.773~4.560,P=0.017;OR=1.939,95%CI:1.577~2.963,P=0.020)。结论 UACR、同型半胱氨酸和高敏C反应蛋白均为原发性高血压患者发生冠心病的相关危险因素,应对这部分人群进行积极的干预和治疗。     

Risk factors in normolipidemic male patients with coronary artery disease in Japanese.

We examined serum lipids, lipoproteins, apolipoproteins (Apo), lipoprotein(a) (Lp(a)), C4b-binding protein (C4bp) and lathosterol in 22 normolipidemic (serum total cholesterol less than 220 mg/dl and serum triglycerides less than 150 mg/dl) male patients with coronary artery disease (CAD) and 33 normal male subjects. Many of the patients in the CAD group with normal total cholesterol (T-Ch) and triglycerides (TG) had higher TG, low-density lipoprotein (LDL)-Ch, beta-lipoprotein (Lipo) and Apo B values and lower high-density lipoprotein (HDL)-Ch, Apo A-I and Apo A-II values than those of the control group. Differences were also observed in the beta-Lipo/HDL-Ch, Apo B/Apo A-I, and HDL-Ch ratios and the atherogenic index [A.I. = (T-Ch--HDL-Ch)/HDL-Ch], all of which are generally accepted as indices for atherosclerosis. Even in CAD patients with normolipidemia, the HDL-Ch/T-Ch ratio and A.I. seemed to be important risk factors. In addition, Lp(a) and lathosterol, an accepted indicator of whole-body cholesterol synthesis, were higher in the CAD group. The CAD group also appeared to have a higher C4bp value, suggesting that this parameter is correlated with other lipids.     

Risk predictors in patients scheduled for percutaneous coronary revascularization.

Traditionally, procedural risks associated with conventional balloon coronary angioplasty have been largely attributed to unfavorable lesion morphology. However, factors predicting adverse events in the current practice of percutaneous coronary revascularization are unclear. The present study was undertaken to determine factors predicting major adverse events (death or Q-wave myocardial infarction or emergency bypass surgery) in 3,335 consecutive patients undergoing percutaneous coronary revascularization in the current practice of percutaneous coronary revascularization. During the period of observation, the rate of lesions treated successfully increased from 91% to 95% (P < 0.0001), whereas the rate of major adverse events (MACE) decreased from 3.6% to 1.6% (odds ratio [OR], 0.70 per year). Using multiple stepwise logistic regression analysis, cardiogenic shock (OR, 8.59; confidence interval [CI], 4.27-17.27), renal disease (OR, 3.33; CI, 1.95-5.69), evolving myocardial infarction (OR, 2.80; CI, 1.47-5.31), congestive heart failure (OR, 2.18; CI, 1.23-3.86), total number of lesions treated (OR, 1.28; CI, 1.03-1.59), age (OR, 1.03; CI, 1.01-1.06), and history of prior coronary intervention (OR, 0.51; CI 0.26-0.99) were identified as independent predictors of MACE. In addition, vascular disease (OR, 2. 48; CI 1.37-4.50) and unstable angina pectoris (OR, 0.44; CI 0.25-0. 79) were related to adverse events when patients in cardiogenic shock were excluded from the model. With the exception of most unfavorable lesion morphology (AHA/ACC lesion type C; OR, 2.05; CI, 1.19-3.52), anatomic parameters added no further information. In the present era of device technology, success rates of percutaneous coronary revascularization procedures have increased and remain to be determined by lesion morphology. In contrast, the rate of MACE is declining and best predicted by easily identified patient characteristics.     

冠状动脉病变长度的相关因素

目的 :探讨冠状动脉长病变的相关因素。方法 :将冠状动脉造影 （CAG）确诊的 15 6例冠心病 （CHD）患者 ,按病变长度分为A型病变组 （A组 ） 5 4例 ;B型病变组 （B组 ） 5 0例 ;C型病变组 （C组 ） 5 2例。设计统一的调查表 ,对患者的社会经济文化背景 ,临床表现 ,CHD常见危险因素以及CAG进行调查和测量 ,比较组间差异 ,并对病变长度与相关因素进行相关和回归分析。结果 :心肌梗死和不稳定型心绞痛发生率 ,组间比较差异显著 （P <0 .0 5、P <0 .0 1） ,C组发生率最高 ,且多支病变为主 （P <0 .0 1） ;稳定型心绞痛 ,组间比较差异非常显著 （P <0 .0 1） ,A组发生率最高 ,主要为单支病变 （P <0 .0 1）。病变长度 ,组间差异非常显著 （P <0 .0 1） ;B ,C组年龄显著大于A组 （P <0 .0 5 ） ,病程显著长于A组 （P <0 .0 1） ,血糖 （FBG）、中性粒细胞计数 （PMN）、C反应蛋白 （CRP）均高于A组 （P <0 .0 1） ;另外C组吸烟指数 （CSI）高于A、B组 ,而射血分数 （EF）低于A、B组 （P <0 .0 1）。长病变分别与年龄、病程、CSI、EF、FPG、PNN、CRP具有相关性 ,统计学上有非常显著的意义 （P <0 .0 1） ,长病变与年龄及病程在不同组中有相依变动的规律 （P <0 .0 1）。结论 :稳定型心绞痛冠脉多是单支的A型病变改变 ,不稳定型心绞痛或心肌梗死冠脉主要为?     

Risk of death related to coronary arteriography: role of left coronary arterial lesions.

Seven deaths occurred within 5 days after study in 800 consecutive patients undergoing arteriography. All seven patients had severe anginal symptoms at rest or with minimal exertion, and all had extensive coronary artery disease. Four had left main coronary artery disease, and three had hemodynamically equivalent lesions involving both the proximal left anterior descending and circumflex branches. It is postulated that these deaths are due to a stress imposed upon patients in unstable condition with a particularly extensive myocardial perfusion deficit.     

Treatment of hypertensive patients with coexisting coronary arterial disease

Despite clear guidelines and an array of available antihypertensive medications, patients with hypertension and coronary artery disease are often inadequately treated. New data from HOPE, LIFE, and ALLHAT underscores the importance of blood pressure reduction for patients with coronary artery disease. Despite our improved understanding of the mechanism by which the various classes of antihypertensive medications achieve their effect, it remains the case that blood pressure reduction remains more important than the medication used to achieve the reduction. For most patients with coronary artery disease, combination therapy will be required to achieve a target blood pressure of less than 140/80. When tolerated, this therapy should include a beta-blocker and ACE inhibitor, both of which are of prognostic benefit for patients with coronary artery disease. There are also attractions in choosing calcium antagonists because of their efficacy in controlling anginal symptoms (Dihydropyridine calcium channel blockers if already on a beta-blocking agent and rate-limiting calcium channel blockers if beta blockers are contraindicated). Thiazide diuretics have proven themselves effective again in the ALLHAT study and are likely to be an integral part of treatment for the great majority of patients with coronary artery disease.     

Seasonal variation of novel arterial stiffness indexes in Japanese hypertensive patients

Background and Objective: Seasonal variation of blood pressure (BP) is well known, and a relationship between increases in BP and the incidence of cardiovascular accidents (CVAs) in the winter has been reported. Parameters of arterial stiffness may exhibit seasonal variation; however, available data are currently limited. Novel arterial stiffness indexes, namely the arterial velocity pulse index (AVI) and arterial pressure–volume index (API), can be determined through usual maneuver for BP measurement during the regular examination in the outpatient clinic.The present study assessed the seasonal variation of AVI and API in 59 hypertensive patients undergoing stable treatment and regularly visiting our outpatient clinic over a period of 30 months.

Methods: BP, pulse rate (PR), AVI, and API were measured using the AVE-1500 (Pasesa) in the sitting position. Six time frames of assessment were established. All measurements (average: 17.9 measurements per person) were sorted using these six time frames, and their averages were used for analysis.

Results: Significant seasonal variations in PR (P < 0.001) and AVI (P < 0.001), along with weak variation in systolic BP (SBP) (P = 0.047) and marginal variation in API (P = 0.055), were confirmed by repeated analysis of variance. SBP, API, and PR were decreased, whereas AVI was increased in the summer. Coefficient variations were SBP 5.1%, PR 4.9%, AVI 12.6%, and API 10.6%.

Conclusion: AVI was associated with reflected wave like as augmentation index. Thus, a high AVI may suggest increased central wave reflection. Although the significance of seasonal variation of AVI remains unknown, AVI may influence seasonal variations in the incidence of CVA.     

老年高血压患者动脉硬化的危险因素分析

目的探讨老年高血压患者动脉硬化的危险因素,为早期预防心脑血管疾病提供临床依据。方法选择老年高血压患者88例,进行无创性动脉硬化监测和血压、血生化指标测定,分别按臂踝脉搏波传导速度(brachialankle pulse wave velocity,baPWV)和踝臂指数(ankle-brachial index,ABI)分为2组:baPWV增高组46例和baPWV正常组42例,ABI低值组38例和ABI正常组50例。结果与baPWV正常组比较,baPWV增高组收缩压[(154.78±18.56)mm Hg vs(146.29±17.64)mm Hg,1mm Hg=0.133kPa]、TG[(1.99±0.42)mmol/L vs(1.77±0.34)mmol/L]、LDL-C[(3.07±0.52)mmol/L vs(2.51±0.44)mmol/L]、空腹血糖[(6.58±2.39)mmol/L vs(5.38±2.25)mmol/L]明显增高,差异有统计学意义(P<0.05,P<0.01)。ABI低值组高血压病程、收缩压、TG、LDL-C、空腹血糖明显高于ABI正常组(P<0.01)。多元逐步回归分析表明,高血压病程、收缩压、LDL-C、空腹血糖是老年高血压患者动脉硬化指标baPWV、ABI异常的独立危险因素。结论长病程、高血压、高胆固醇血症、高血糖与baPWV、ABI密切相关,促进老年高血压患者动脉硬化的发生、发展。     

Long-term incidence and prognostic factors of the progression of new coronary lesions in Japanese coronary artery disease patients after percutaneous coronary intervention

Revascularization of an initially non-target site due to its progression as a new culprit lesion has emerged as a new therapeutic target of coronary artery disease (CAD) in the era of drug-eluting stents. Using the Shinken database, a single-hospital-based cohort, we aimed to clarify the incidence and prognostic factors for progression of previously non-significant coronary portions after prior percutaneous coronary intervention (PCI) in Japanese CAD patients. We selected from the Shinken database a single-hospital-based cohort of Japanese patients (n = 15227) who visited the Cardiovascular Institute between 2004 and 2010 to undergo PCI. This study included 1,214 patients (median follow-up period, 1,032 ± 704 days). Additional clinically driven PCI to treat previously non-significant lesions was performed in 152 patients. The cumulative rate of new-lesion PCI was 9.5 % at 1 year, 14.4 % at 3 years, and 17.6 % at 5 years. There was no difference in background clinical characteristics between patients with and without additional PCI. Prevalence of multi-vessel disease (MVD) (82 vs. 57 %, p < 0.001) and obesity (47 vs. 38 %, p = 0.028) were significantly higher and high-density lipoprotein cholesterol (HDL) level (51 ± 15 vs. 47 ± 12 mg/dl, p < 0.001) was significantly lower in patients with additional PCI than those without. Patients using insulin (6 vs. 3 %, p = 0.035) were more common in patients with additional PCI. Multivariate analysis showed that MVD, lower HDL, and insulin use were independent determinants of progression of new culprit coronary lesions. In conclusion, progression of new coronary lesions was common and new-lesion PCI continued to occur beyond 1 year after PCI without attenuation of their annual incidences up to 5 years. Greater coronary artery disease burden, low HDL, and insulin-dependent DM were independent predictors of progression of new culprit coronary lesions.     

Risk factors and predictors of outcome in patients with cancer and breakthrough candidemia.

Hematogenous candidiasis adds substantially to the morbidity and mortality rates of patients with cancer. Little is known about the risk factors and outcome in patients with breakthrough (BT) candidemia while on systemic antifungal therapy. All 479 episodes of candidemia in 474 consecutive patients with candidemia that was diagnosed at M. D. Anderson Cancer Center from 1988 through 1992 were studied retrospectively. A total of 49 patients had BT candidemia, defined as candidemia that developed after at least 5 days of systemic antifungal therapy. Risk factors for BT candidemia and predictors of mortality were investigated. Multivariate analysis revealed that intensive care unit stay, neutropenia, use of corticosteroids, and duration of neutropenia as significant risk factors for BT candidemia. Seventy-six percent of patients with BT candidemia died, compared with 50% of patients with non-BT infection. In multivariate analysis, intensive care unit stay, being and remaining neutropenic, APACHE III score, and disseminated disease were independent prognostic factors. In conclusion, identification of risk factors and predictors of a poor outcome in patients with cancer with BT candidemia may have important implications in early diagnosis and appropriate therapy of these patients.     

Risk factors that discriminate 'high- risk' from 'low-risk' Japanese patients with coronary artery disease

Although various risk factors have been implicated in the progression of coronary artery disease (CAD), coronary risk factors specifically related to the long-term prognosis for high-risk CAD have not been determined. The study enrolled 311 consecutive Japanese patients with CAD who underwent diagnostic coronary arteriography and divided them into 2 groups: (i) 135 high-risk patients with either impaired left ventricular function (ejection fraction <50%) or multivessel disease and (ii) 176 low-risk patients with normal left ventricular function and 0- or 1-vessel disease. The prevalence of risk factors including age, gender, smoking, hypertension, diabetes mellitus (DM), obesity and lipid variables were compared between the 2 groups. The prevalence of DM, a serum high-density lipoprotein (HDL)-cholesterol level below 35 mg/dl and a serum lipoprotein (Lp) (a) level above 25 mg/dl was significantly higher in the high-risk group as compared with the low-risk group. Multiple logistic regression analysis demonstrated that DM (odds ratio (OR): 1.72, 95% confidence intervals (CI): 1.02-2.92, p<0.05), a low HDL-cholesterol level (OR: 2.49, 95% CI: 1.49-4.17, p<0.001) and a high Lp(a) level (OR: 1.68, 95% CI: 1.02-2.76, p<0.05) were all independent risk factors for high-risk CAD. However, if the patients with 0-vessel disease were excluded from the low-risk group, a low HDL-cholesterol level was found to be the only independent predictor for high-risk CAD (OR: 2.07, 95% CI: 1.15-3.70, p<0.05). Among both men and smokers in this population, a higher Lp(a) level was found to be a significant predictor for high-risk CAD. A low serum level of HDL-cholesterol, a high serum level of Lp(a) and DM were significant predictors of high-risk in patients with CAD. Among patients with a significant coronary stenosis or left ventricular dysfunction, a low serum level of HDL-cholesterol was the only significant predictor for high-risk CAD.     

中老年女性冠心病危险因素和冠状动脉病变特点研究

目的 探讨50岁以上各年龄段女性冠状动脉粥样硬化性心脏病（冠心病）患者危险因素和冠状动脉病变的特点.方法 回顾性分析126例行冠状动脉造影的女性冠心病患者的临床资料,根据年龄分为3组：G1组（50～60岁）,G2组（61～70岁）,G3组（＞70岁）,观察各组既往病史、生化指标与冠心病发病的关系,分析各组冠状动脉病变的特点.结果（1）从G1组到G3组,原发性高血压（高血压）患病率分别为41.4％、62.3％、68.2％,逐渐升高;入院时收缩压为（129.2±22.4）mm Hg（1 mm Hg=0.133 kPa）、（133.7±18.6）mm Hg、（140.8±21.4）mm Hg,G3组与G1组比较差异有统计学意义（P＜0.05）.（2）G1、G2组单支血管病变发生率较高为48.5％、56.6％;G3组三支血管病变发生率较高为45.5％,与G1、G2组相比,差异有统计学意义（P＜0.05）.（3）改良Gensini评分3组分别为（6.6±3.1）分、（7.3±3.0）分、（7.7±3.0）分,3组比较差异无统计学意义（P＞0.05）.结论 高血压病史和收缩压高为中老年女性冠心病患者的独立危险因素;70岁以下女性冠心病患者病变以单支血管病变为主,70岁以上女性冠心病患者以三支血管病变更为多见,并且随着年龄增加,冠状动脉病变程度逐渐加重.     

Fibrinolytic factors, serum lipid and C-reactive protein predicting cardiac events in Japanese patients with coronary atherosclerotic lesions

Although disturbances of the fibrinolytic system and serum lipid, and the presence of inflammation, may be risk factors for coronary artery disease (CAD), few reports have investigated these relationships in Japanese patients. Data on 106 patients (79 men and 27 women, mean age 62.3 years) with atherosclerotic lesions on the coronary angiogram were evaluated prospectively to identify whether the factors were useful in predicting the risk of coronary events during a follow-up of 50+/-4 months. Of the 106 patients who were followed, 11 patients had coronary events (4 acute myocardial infarction and 7 unstable angina pectoris). In univariate Cox analyses, a high level of tissue-plasminogen activator (t-PA), apolipoprotein CII, C-reactive protein (CRP), and a low level of high-density lipoprotein-cholesterol (HDL-C) was each associated with a significant increase in the risk of future cardiac events. The stepwise model of Cox proportional hazards analysis selected only a high level of t-PA and CRP as predictors of cardiac events. Controlling for any risk factor did not lower the relation between t-PA and the risk of cardiac events, whereas the relative risk of cardiac events in CRP was not significant when controlled for HDL-C. Thus, in prospective data obtained from a cohort of Japanese patients with coronary atherosclerotic lesions, the elevation of t-PA was an independent predictor of subsequent cardiac events. The prognostic role of CRP in cardiac events was related to a low level of HDL-C.     

Carotid artery lesions and atherosclerotic risk factors in Japanese hemodialysis patients

To determine the prevalence and severity of carotid artery lesions and which risk factors might be responsible for atherosclerosis in end-stage renal disease (ESRD) patients, we tested for carotid atherosclerosis (CA) by ultrasonography and compared the CA prevalence with well-known or suspected atherosclerotic risk factors in 226 hemodialysis (HD) patients and 2410 healthy residents of Japan. The CA prevalence was higher in the HD patients than in the healthy residents. Univariate analysis showed that HD patients with CA had a higher frequency of diabetes mellitus and left ventricular hypertrophy, and were significantly older, had significantly higher systolic blood pressure and pulse pressure, and lower albumin levels than those without. Multivariate analysis showed that age, pulse pressure, phosphorus, duration of HD, and diabetes mellitus were independent, significant predictors for CA in the HD patients. Neither Chlamydia pneumoniae seropositivity nor elevated homocysteine level was independently, significantly associated with CA. Our results suggest that HD patients had more advanced CA than the healthy residents. CA in the HD patients may be associated not only with several conventional risk factors but also with non-conventional risk factors such as phosphorus and the HD procedure itself.     

Magnetic resonance coronary angiography to evaluate coronary arterial lesions in patients with Kawasaki disease

We evaluated the efficiency of non-invasive magnetic resonance coronary angiography in detecting coronary arterial lesions in 106 patients, aged from 4 months to 37 years, with a median of 13 years, with Kawasaki disease. Non-contrast enhanced, free-breathing magnetic resonance coronary angiographic studies using both the steady-state free precession technique, namely bright blood imaging, and navigator-echo proton density weighted black blood imaging, so-called black blood imaging, were performed in all the patients. Conventional X-ray coronary angiography was performed in 70 patients with coronary arterial lesions.We observed 97 aneurysms, 17 dilatations, 17 occlusions, 18 localized stenoses and 10 recanalized vessels, and we clarified their unique pattern of images on magnetic resonance coronary angiography. The differences in size of the aneurysms as seen on X-ray coronary angiography and bright blood imaging was mean 0.0, and the 95% confidence interval was from -1.4 to 1.5 on the Bland-Altman plots. With bright blood imaging, the sensitivity of occlusion and localized stenosis based on X-ray angiography was 94.2% and 97.2%, specificity was 99.5% and 97.2%, and negative-predictive value was 99.5% and 97.2%, respectively. Black blood imaging provided remarkable visualization of the thickened intima of aneurysms, and/or thrombus, in 38 lesions. We conclude that magnetic resonance coronary angiography can visualize all types of lesions due to Kawasaki disease in patients of all ages, and that it is useful to reduce the number of times X-ray angiography needs to be performed in patients with Kawasaki disease.     

高血压病患者发生心房颤动的相关危险因素临床分析

目的:探讨高血压病患者发生心房颤动(AF)的临床相关危险因素。方法:将423例高血压病患者分为高血压病合并AF(n=233),不合并AF(n=190)两组,回顾性分析比较两组患者的临床资料,并进行Logistic回归分析高血压病患者发生AF的可能危险因素。结果:单变量分析显示,与非AF组相比,AF组的年龄较大(P<0.001)、体重指数偏高(P=0.019),心脏超声测量左心房内径、左室舒张末期内径和左室收缩末期内径均偏大(P<0.001),左室射血分数(P=0.005)较低。肌酐(P<0.001)和尿酸水平(P=0.013)偏高,但总胆固醇及低密度脂蛋白胆固醇水平(P<0.001)较低。Logistic多因素回归分析提示,年龄(OR=1.08,95%CI:1.04～1.13,)、左心房内径(OR=1.51,95%CI:1.38～1.63)、低密度脂蛋白胆固醇含量(OR=0.52,95%CI:0.36～0.78)与高血压病患者发生AF存在显著的关联关系。结论:年龄及左心房内径越大、低密度脂蛋白胆固醇水平越低的高血压病患者发生AF的危险性高。     

Risk factors and outcomes in patients with coronary artery aneurysms

Previous small series have provided conflicting data on the association between coronary artery aneurysms and traditional cardiac risk factors, as well as limited information on patient outcomes. This investigation sought to determine whether the presence of coronary artery aneurysms has an adverse affect on patient outcomes. The results show that coronary aneurysms were an independent predictor of mortality, and overall 5-year survival in patients with aneurysms was only 71%. We believe that clinicians should aggressively monitor and modify coronary risk factors in patients with coronary aneurysms.     

Abnormal endothelium-dependent coronary vasomotion in hypertensive patients.

Coronary vasomotion is abnormal in hypertensive patients, as evidenced by reduced coronary vasodilator reserve, but endothelium-dependent coronary vasomotion in hypertensive patients has not been studied. To assess the integrity of endothelium-dependent vasodilation, the response of coronary arteries to acetylcholine (an endothelium-dependent vasodilator) and nitroglycerin (an endothelium-independent vasodilator) was studied in 14 patients undergoing cardiac catheterization. Eight patients with essential hypertension were compared with six normotensive patients. None had obstructive disease detectable by coronary arteriography. Coronary artery diameter was measured with digital-subtracted arteriography and coronary blood flow velocity with a Doppler flow velocity catheter. At baseline, coronary artery diameter was similar in the hypertensive and the normotensive control patients (2.4 +/- 0.3 vs. 2.8 +/- 0.7 mm). During intracoronary acetylcholine infusion (30 micrograms/min), coronary artery diameter decreased to 1.3 +/- 0.7 mm in the hypertensive patients (p less than 0.005), but was unchanged (2.7 +/- 0.8 mm) in the normotensive patients. With intracoronary nitroglycerin (200 micrograms), coronary artery diameter increased significantly in both groups. Calculated coronary blood flow decreased during acetylcholine infusion by 59 +/- 31% in the hypertensive patients but increased by 3 +/- 3% in the normotensive group (p less than 0.005). There was a significant negative correlation between the percent change in estimated coronary blood flow during acetylcholine infusion and mean arterial pressure measured at baseline (r = 0.67, p less than 0.02). Therefore, these hypertensive patients exhibited marked coronary vasoconstriction in response to intracoronary acetylcholine but normal vasodilation in response to nitroglycerin, suggesting abnormal endothelium-dependent vasodilation.(ABSTRACT TRUNCATED AT 250 WORDS)