Original articles

Survey of risk factors of coronary heart disease in elderly patients with coronary angiography and establishment of relevant diagnostic model

Expand
  • Department of Geriatrics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China

Received date: 2021-03-01

  Online published: 2022-06-28

Abstract

Objective: To investigate the major risk factors for coronary heart disease (CHD) in elderly patients (≥75 years old) using coronary angiography and develop relevant diagnostic model. Methods: Retrospective analysis was conduc-ted on 548 elderly patients with suspected diagnosis of CHD(≥75 years old) underwent coronary angiography (CAG) treatment in Ruijin Hospital from June 2018 to December 2019. According to CAG results, the patients were divided into two groups :CHD group and control group. The risk factors were analyzed by multivariate Logistic regression, and the predictive value of these factors for the occurrence of CHD in the elderly was evaluated by receiver operator characteristic curve (ROC curve). Results: There were 408 cases in the CHD group and 140 cases in the control group based on results of CAG. The multivariate Logistic regression analysis after baseline analysis showed that elevated level of troponin I(OR=6.828, 95%CI:3.834-12.160, P<0.001), carotid plaque formation(OR=3.440, 95%CI: 1.780-6.650, P<0.001), elevated level of HbA1c(OR=1.532, 95%CI: 1.182-1.987, P=0.001) and white blood cell (WBC) counts (OR=1.187, 95%CI: 1.027-1.371, P=0.021) were risk factors for elderly patients with CHD, While female(OR=0.329, 95%CI: 0.201-0.538, P<0.001), elevated level of direct bilirubin(OR=0.800, 95%CI: 0.679-0.942, P=0.008) and elevated level of hemoglobin(OR=0.976, 95%CI: 0.960-0.992, P=0.003) were protective factors for CHD in elderly patients. The area under the curve of the ROC curve model established with above 7 factors for recognizing CHD in elderly patients was 0.825(P<0.05), with a good diagnostic performance. Conclusions:Unlike the risk factors established among the whole population, such as diabetes, high blood pressure, smoking, hyperlipidemia, obesity and high homocysteine, the increased level of troponin I and carotid artery plaque formation are major risk factors for CHD in the elderly. However, the female gender are potential protective factors for CHD. The corresponding diagnostic model is of certain value for identifying high-risk patients from patients suspected of CHD, and may help reduce excessive and unreasonable use of CAG.

Cite this article

WU Jie, FENG Yuanyuan, REN Yan, CAO Jiumei . Survey of risk factors of coronary heart disease in elderly patients with coronary angiography and establishment of relevant diagnostic model[J]. Journal of Diagnostics Concepts & Practice, 2021 , 20(02) : 201 -206 . DOI: 10.16150/j.1671-2870.2021.02.015

References

[1] GBD 2016 Disease and Injury Incidence and Prevalence Collaborators. Global, regional, and national incidence, prevalence, and years lived with disability for 328 di-seases and injuries for 195 countries, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016[J]. Lancet, 2017, 390(10100):1211-1259.
[2] Benjamin EJ, Blaha MJ, Chiuve SE, et al. Heart disease and stroke statistics-2017 update: a report from the American Heart Association[J]. Circulation, 2017, 135(10):e146-e603.
[3] Gheorghe A, Griffiths U, Murphy A, et al. The economic burden of cardiovascular disease and hypertension in low- and middle-income countries: a systematic review[J]. BMC Public Health, 2018, 18(1):975.
[4] 马丽媛, 吴亚哲, 陈伟伟. 中国心血管病报告2018要点介绍[J]. 中华高血压杂志, 2019, 27(8):712-716.
[5] Scanlon PJ, Faxon DP, Audet AM, et al. ACC/AHA guidelines for coronary angiography: executive summary and recommendations. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Coronary Angiography) developed in collaboration with the Society for Cardiac Angiography and Interventions[J]. Circulation, 1999, 99(17):2345-2357.
[6] Hanrahan MT, O'Flynn AM, McHugh SM, et al. Appropriate use of elective coronary angiography in patients with suspected stable coronary artery disease[J]. Ir J Med Sci, 2019, 188(3):807-813.
[7] Lian D, Liu Y, Liu YH, et al. Pre-procedural risk score of contrast-induced nephropathy in elderly patients undergoing elective coronary angiography[J]. Int Heart J, 2017, 58(2):197-204.
[8] Gudnadottir GS, James SK, Andersen K, et al. Outcomes after STEMI in old multimorbid patients with complex health needs and the effect of invasive management[J]. Am Heart J, 2019, 211:11-21.
[9] Pizzi C, Xhyheri B, Costa GM, et al. Nonobstructive versus obstructive coronary artery disease in acute coronary syndrome: a meta-analysis[J]. J Am Heart Assoc, 2016, 5(12):e004185.
[10] Bai MF, Wang X. Risk factors associated with coronary heart disease in women: a systematic review[J]. Herz, 2020, 45(Suppl 1):52-57.
[11] Garshick MS, Vaidean GD, Vani A, et al. Cardiovascular risk factor control and lifestyle factors in young to middle-aged adults with newly diagnosed obstructive coronary artery disease[J]. Cardiology, 2019, 142(2):83-90.
[12] Peltzer S, Hellstern M, Genske A, et al. Health literacy in persons at risk of and patients with coronary heart di-sease: a systematic review[J]. Soc Sci Med, 2020, 245:112711.
[13] Boos CJ, de Villiers N, Dyball D, et al. The relationship between military combat and cardiovascular risk: a systematic review and meta-analysis[J]. Int J Vasc Med, 2019, 2019:9849465.
[14] Garg P, Morris P, Fazlanie AL, et al. Cardiac biomarkers of acute coronary syndrome: from history to high-sensiti-vity cardiac troponin[J]. Intern Emerg Med, 2017, 12(2):147-155.
[15] Hammarsten O, Mair J, Möckel M, et al. Possible me-chanisms behind cardiac troponin elevations[J]. Biomar-kers, 2018, 23(8):725-734.
[16] He J, Chen P, Luo Y, et al. Relationship between the maximum carotid plaque area and the severity of coronary atherosclerosis[J]. Int Angiol, 2018, 37(4):300-309.
[17] Mantella LE, Colledanchise KN, Hétu MF, et al. Carotid intraplaque neovascularization predicts coronary artery disease and cardiovascular events[J]. Eur Heart J Cardiovasc Imaging, 2019, 20(11):1239-1247.
[18] Wang WT, Hsu PF, Lin CC, et al. Hemoglobin A1C le-vels are independently associated with the risk of coronary atherosclerotic plaques in patients without diabetes: a cross-sectional study[J]. J Atheroscler Thromb, 2020, 27(8):789-800.
[19] Leong A, Chen J, Wheeler E, et al. Mendelian rando-mization analysis of hemoglobin A 1c as a risk factor for coronary artery disease[J]. Diabetes Care, 2019, 42(7):1202-1208.
[20] Ewid M, Sherif H, Billah SMB, et al. Glycated hemoglobin predicts coronary artery disease in non-diabetic adults[J]. BMC Cardiovasc Disord, 2019, 19(1):309.
[21] Kristono GA, Holley AS, Harding SA, et al. White blood cell subtypes as predictors of adverse cardiac events[J]. Coron Artery Dis, 2020, 31(5):446-450.
[22] Morici N, Molinari V, Cantoni S, et al. Long-term risk of major adverse cardiovascular events in patients with acute coronary syndrome: prognostic role of complete blood cell count[J]. Angiology, 2020, 71(9):831-839.
[23] Kalra PR, Greenlaw N, Ferrari R, et al. Hemoglobin and change in hemoglobin status predict mortality, cardiovascular events, and bleeding in stable coronary artery disease[J]. Am J Med, 2017, 130(6):720-730.
[24] Erkan A, Ekici B, Uǧurlu M, et al. The role of bilirubin and its protective function against coronary heart disease[J]. Herz, 2014, 39(6):711-715.
[25] Lai X, Fang Q, Yang L, et al. Direct, indirect and total bilirubin and risk of incident coronary heart disease in the Dongfeng-Tongji cohort[J]. Ann Med, 2018, 50(1):16-25.
[26] Wilson PW, D'Agostino RB, Levy D, et al. Prediction of coronary heart disease using risk factor categories[J]. Circulation, 1998, 97(18):1837-1847.
[27] Hannan EL, Samadashvili Z, Cozzens K, et al. Appro-priateness of diagnostic catheterization for suspected coro-nary artery disease in New York State[J]. Circ Cardiovasc Interv, 2014, 7(1):19-27.
[28] Luciano LSC, Silva RLD, Londero Filho OM, et al. Ana-lysis of the appropriate use criteria for coronary angiog-raphy in two cardiology services of southern brazil[J]. Arq Bras Cardiol, 2019, 112(5):526-531.
Outlines

/