青年男性冠心病的危险因素及Framingham风险评分的预测价值

doi:10.3969/j.issn.1006-7795.2022.01.024

摘要/Abstract

摘要： 目的探讨青年男性冠状动脉粥样硬化性心脏病(以下简称冠心病)的危险因素及Framingham风险评分的预测价值。方法选取 2016年7月至 2019 年7月期间在首都医科大学附属北京地坛医院行冠状动脉造影术的201例青年男性患者作为研究对象(30≤年龄<45岁),按照冠状动脉造影结果分为冠心病病例组(n=139)和非冠心病对照组(n=62)。所有患者计算Framingham危险评分(Framingham Risk Score,FRS),两组患者根据FRS,分别分为低危险组、中/高危险组两个亚组。冠心病患者根据Gensini评分法评估冠状动脉病变严重程度,收集所有研究对象的病史及相关临床与实验室检测指标。结果冠心病组患者合并吸烟、高血压、早发冠心病家族史的比例高于非冠心病组,高密度脂蛋白胆固醇(high density lipoprotein-cholesterol,HDL-C)水平低于非冠心病组,非高密度脂蛋白胆固醇(non-high density lipoprotein-cholesterol, non-HDL-C)、载脂蛋白B/载脂蛋白A(apolipoprotein B/apolipoprotein A,ApoB/ApoA)、三酰甘油(triglyceride,TG)、同型半胱氨酸(homocysteine,HCY)、糖化血红蛋白(glycosylated hemoglobin,HbA1c)水平高于非冠心病组,差异均有统计学意义(P<0.05)。冠心病组与非冠心病组患者Framingham 危险评分均值及两组患者中Framingham风险评分低危险组、中/高危险亚组患者比例,差异均无统计学意义(P>0.05)。冠心病组患者Framingham 危险评分与Gensini积分两者无线性相关性(P=0.749)。多因素 Logistic 回归分析结果显示,高血压、冠心病早发家族史、HCY为青年男性冠心病的独立危险因素(P<0.05),HDL-C为青年男性冠心病患者的保护因素。Framingham风险评分的受试者工作特征(receiver operating characteristic,ROC)曲线的曲线下面积为0.544(95%CI: 0.458~0.629,P=0.324)。结论 Framingham危险评分不能充分预测评估青年男性冠心病患者冠状动脉疾病的严重程度,青年男性早发冠心病患者应考虑非传统的冠心病危险因素的重要性,未来需更多样本的前瞻性研究验证。

关键词: 青年男性, 早发冠心病, 福明翰风险评分, Gensini 积分

Abstract: Objective To investigate the risk factors and predictive value of Framingham Risk Score of young men with coronary artery disease (CAD).Methods A total of 201 young male patients (30≤age<45 years old) who underwent coronary angiography in Beijing Ditan Hospital, Capital Medical University from July 2016 to July 2019 were selected as the research subjects. According to the results of coronary angiography, they were divided into two groups: CAD group (n=139) and non-CAD group (n=62). Framingham Risk Score was calculated for all patients, and patients in both groups were divided into two subgroups according to Framingham Risk Score: low risk group and high risk group/moderate risk group. The severity of coronary artery disease in patients with CAD was assessed by Gensini score, and the medical history and relevant clinical and laboratory indicators of all subjects were collected. Results The proportions of smoking, hypertension and family history of CAD in CAD group were higher than those in non-CAD group (P<0.05).There were significant differences in high density lipoprotein-cholesterol (HDL-C), ApoB/ApoA and non-HDL-C in CAD group (P<0.05). There was no statistical difference in the mean Framingham Risk Score between CAD group and non-CAD group as well as the proportion of patients in the low-risk Framingham Risk Score and the medium/high risk Framingham Risk Score. Further analysis of the correlation between the Framingham Risk Score and Ginsini Score in the CAD group showed no linear correlation (P=0.749).The area under the receiver operating characteristic (ROC) curve of the Framingham Risk Score was 0.544 (95%CI: 0.458-0.629, P =0.324).Binary linear multivariate Logistic regression analysis showed that hypertension, family history of premature coronary atery disease and homocysteine (HCY) were independent risk factors for coronary heart disease in young men,while HDL-C is a protective factor in these samples. Conclusion A single-center cross-sectional study shows that Framingham Risk Score cannot adequately assess coronary artery severity in young male patients with CAD. The importance of non-traditional CAD risk factors should be considered in young male patients with early onset CAD, and future prospective studies with more samples are needed to verify this.

Key words: young men, premature coronary artery disease, Framingham Risk Score, Gensini Score

中图分类号:

R541.4

苏云娟, 王京京, 韩晓涛, 刘海燕, 陈永福, 杨柳, 吴其明. 青年男性冠心病的危险因素及Framingham风险评分的预测价值[J]. 首都医科大学学报, 2022, 43(1): 143-148.

Su Yunjuan, Wang Jingjing, Han Xiaotao, Liu Haiyan, Chen Yongfu, Yang Liu, Wu Qiming. Risk factors and predictive value of Framingham Risk Score of young men with coronary artery disease[J]. Journal of Capital Medical University, 2022, 43(1): 143-148.

参考文献

[1] Bauersachs R, Zeymer U, Brière J B, et al. Burden of coronary artery disease and peripheral artery disease: a literature review[J]. Cardiovasc Ther, 2019, 2019: 8295054.
[2] Fan F F, Li Y X, Zhang Y, et al. Chest pain center accreditation is associated with improved In-Hospital outcomes of acute myocardial infarction patients in China: findings from the CCC-ACS project[J]. J Am Heart Assoc, 2019, 8(21): e013384.
[3] Zheng W, Wang J L, Xu F, et al. Evaluation and management of patients with acute chest pain in China (EMPACT): protocol for a prospective, multicentre registry study[J]. BMJ Open, 2018, 8(1): e017872.
[4] Andersson C, Vasan R S. Epidemiology of cardiovascular disease in young individuals[J]. Nat Rev Cardiol, 2018, 15(4): 230-240.
[5] Marma A K, Lloyd-Jones D M. Systematic examination of the updated Framingham heart study general cardiovascular risk profile[J]. Circulation, 2009, 120(5): 384-390.
[6] Malakar A K, Choudhury D, Halder B, et al. A review on coronary artery disease, its risk factors, and therapeutics[J]. J Cell Physiol, 2019, 234(10): 16812-16823.
[7] Khera A V, Kathiresan S. Genetics of coronary artery disease: discovery, biology and clinical translation[J]. Nat Rev Genet, 2017, 18(6): 331-344.
[8] Ibanez B, James S, Agewall S, et al. 2017 ESC guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation[J]. Kardiol Pol, 2018, 76(2): 229-313.
[9] Liu S W, Li Y C, Zeng X Y, et al. Burden of cardiovascular diseases in China, 1990-2016: findings from the 2016 global burden of disease study[J]. JAMA Cardiol, 2019, 4(4): 342-352.
[10] Zeitouni M, Clare R M, Chiswell K, et al. Risk factor burden and long-term prognosis of patients with premature coronary artery disease[J]. J Am Heart Assoc, 2020, 9(24): e017712.
[11] Ge J, Li J, Yu H, et al.Hypertension Is an Independent Predictor of Multivessel Coronary Artery Disease in Young Adults with Acute Coronary Syndrome[J]. Int J Hypertens,2018,2018:7623639.
[12] Christiansen M K, Jensen J M, Nørgaard B L, et al. Coronary plaque burden and adverse plaque characteristics are increased in healthy relatives of patients with early onset coronary artery disease[J]. JACC Cardiovasc Imaging, 2017, 10(10 Pt A): 1128-1135.
[13] Kaur R, Das R, Ahluwalia J, et al. Genetic polymorphisms, biochemical factors, and conventional risk factors in young and elderly north Indian patients with acute myocardial infarction[J]. Clin Appl Thromb Hemost, 2016, 22(2): 178-183.
[14] Jortveit J, Pripp A H, Langørgen J, et al. Incidence, risk factors and outcome of young patients with myocardial infarction[J]. Heart, 2020, 106(18): 1420-1426.
[15] Koller A, Szenasi A, Dornyei G, et al. Coronary microvascular and cardiac dysfunction due to homocysteine pathometabolism; a complex therapeutic design[J]. Curr Pharm Des, 2018, 24(25): 2911-2920.
[16] Jakubowski H. Homocysteine modification in protein structure/function and human disease[J]. Physiol Rev, 2019, 99(1): 555-604.
[17] Djuric D, Jakovljevic V, Zivkovic V, et al. Homocysteine and homocysteine-related compounds: an overview of the roles in the pathology of the cardiovascular and nervous systems[J]. Can J Physiol Pharmacol, 2018, 96(10): 991-1003.
[18] Li T Y, Yu B, Liu Z X, et al. Homocysteine directly interacts and activates the angiotensin II type I receptor to aggravate vascular injury[J]. Nat Commun, 2018, 9(1): 11.
[19] Visram M, Radulovic M, Steiner S, et al. Homocysteine regulates fatty acid and lipid metabolism in yeast[J]. J Biol Chem, 2018, 293(15): 5544-5555.
[20] Jud P, Hafner F, Verheyen N, et al. Age-dependent effects of homocysteine and dimethylarginines on cardiovascular mortality in claudicant patients with lower extremity arterial disease[J]. Heart Vessels, 2018, 33(12): 1453-1462.
[21] Xie J C, Qi J, Mao H Y, et al. Coronary plaque tissue characterization in patients with premature coronary artery disease[J]. Int J Cardiovasc Imaging, 2020, 36(6): 1003-1011.
[22] Kaplan P, Tatarkova Z, Sivonova M K, et al. Homocysteine and mitochondria in cardiovascular and cerebrovascular systems[J]. Int J Mol Sci, 2020, 21(20): 7698.
[23] Ikram S, Pachika A, Schuster H, et al. Single-center retrospective study of risk factors and predictive value of Framingham risk score of patients with ST elevation myocardial infarction[J]. South Med J, 2018, 111(4): 226-229.