Extent of Coronary Artery Disease in Patients With Stenotic Bicuspid Versus Tricuspid Aortic Valves

Background Bicuspid aortic valve (BAV) is the most common congenital cardiac malformation, which is often complicated by aortic valve stenosis (AoS). In tricuspid aortic valve (TAV), AoS strongly associates with coronary artery disease (CAD) with common pathophysiological factors. Yet, it remains unclear whether AoS in patients with BAV is also associated with CAD. This study investigated the association between the aortic valve morphological features and the extent of CAD. Methods and Results A single‐center study was performed, including all patients who underwent an aortic valve replacement attributable to AoS between 2006 and 2019. Coronary sclerosis was graded on preoperative coronary angiographies using the coronary artery greater even than scoring method, which divides the coronaries in 28 segments and scores nonobstructive (20%–49% sclerosis) and obstructive coronary sclerosis (>49% sclerosis) in each segment. Multivariate analyses were performed, controlling for age, sex, and CAD risk factors. A total of 1296 patients (931 TAV and 365 BAV) were included, resulting in 548 matched patients. Patients with TAV exhibited more CAD risk factors (odds ratio [OR], 2.66; 95% CI, 1.79–3.96; P <0.001). Patients with BAV had lower coronary artery greater even than 20 (1.61±2.35 versus 3.60±2.79) and coronary artery greater even than 50 (1.24±2.43 versus 3.37±3.49) scores ( P <0.001), even after correcting for CAD risk factors ( P <0.001). Patients with TAV more often needed concomitant coronary revascularization (OR, 3.50; 95% CI, 2.42–5.06; P <0.001). Conclusions Patients with BAV who are undergoing surgery for AoS carry a lower cardiovascular risk profile, correlating with less coronary sclerosis and a lower incidence of concomitant coronary revascularization compared with patients with TAV.

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Prevalence, Epidemiological Characteristics, and Pharmacotherapy of Coronary Artery Disease among Patients with Atrial Fibrillation: Data from Jo-Fib Study

Medicina ◽

10.3390/medicina57060605 ◽

2021 ◽

Vol 57 (6) ◽

pp. 605

Author(s):

Hanna K. Al-Makhamreh ◽

Mohammed Q. Al-Sabbagh ◽

Ala’ E. Shaban ◽

Abdelrahman F. Obiedat ◽

Ayman J. Hammoudeh

Keyword(s):

Risk Factors ◽

Atrial Fibrillation ◽

Coronary Artery Disease ◽

Coronary Artery ◽

Antiplatelet Agents ◽

Retrospective Case ◽

Increased Risk ◽

Artery Disease ◽

Epidemiological Characteristics ◽

Cad Risk

Background and Objectives: Patients with AF are at increased risk for Coronary Artery Disease (CAD) owing to their shared etiologies and risk factors. This study aimed to assess the prevalence, cardiovascular risk factors, and used medications of CAD in AF patients. Materials and Methods: This retrospective, case-control study utilized data from the Jordanian Atrial Fibrillation (Jo-Fib) registry. Investigators collected clinical features, history of co-existing comorbidities, CHA2DS2-VASc, and HAS BLED scores for all AF patients aged >18 visiting 19 hospitals and 30 outpatient cardiology clinics. A multivariable binary logistic regression was used to asses for factors associated with higher odds of having CAD. Results: Out of 2000 patients with AF, 227 (11.35%) had CAD. Compared to the rest of the sample, those with CAD had significantly higher prevalence of hypertension (82.38%; p < 0.01), hypercholesterolemia (66.52%, p < 0.01), diabetes (56.83%, p < 0.01), and smoking (18.06%, p = 0.04). Patients with AF and CAD had higher use of anticoagulants/antiplatelet agents combination (p < 0.01) compared to the rest of the sample. Females had lower CAD risk than males (OR = 0.35, 95% CI: 0.24–0.50). AF Patients with dyslipidemia (OR = 2.5, 95% CI: 1.8–3.4), smoking (OR = 1.7, 95% CI: 1.1–2.6), higher CHA2DS2-VASc score (OR = 1.5, 95% CI: 1.4–1.7), and asymptomatic AF (OR = 1.9, 95% CI: 1.3–2.6) had higher risk for CAD. Conclusions: Owing to the increased prevalence of CAD in patients with AF, better control of cardiac risk factors is recommended for this special group. Future studies should investigate such interesting relationships to stratify CAD risk in AF patients. We believe that this study adds valuable information regarding the prevalence, epidemiological characteristics, and pharmacotherapy of CAD in patients with AF.

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Abstract 12291: Contribution of Rare Mutations in Mendelian Hypercholesterolemia Genes to Risk for Premature Coronary Artery Disease in the Population

Circulation ◽

10.1161/circ.130.suppl_2.12291 ◽

2014 ◽

Vol 130 (suppl_2) ◽

Author(s):

Hong-Hee Won ◽

Ron Do ◽

Keyword(s):

Coronary Artery Disease ◽

Coronary Artery ◽

Null Allele ◽

Coronary Revascularization ◽

Null Alleles ◽

Premature Coronary Artery Disease ◽

Rare Mutations ◽

Increased Risk ◽

Artery Disease ◽

Cad Risk

Introduction: Low-density lipoprotein cholesterol (LDL-C) is a causal risk factor for coronary artery disease (CAD). Rare mutations in at least 6 genes lead to Mendelian forms of high or reduced LDL-C; three ( APOB, LDLR, PCSK9 ) act in a dominant pattern whereas three ( ABCG5, ABCG8, LDLRAP1 ) in a recessive pattern. We address to what extent rare mutations in Mendelian LDL-C genes contribute to early CAD risk in the population. Methods: We sequenced the exons of the 6 genes in 9,329 early CAD cases (myocardial infarction, angiographic CAD, or coronary revascularization in men≤50 and women≤60) and 10,245 controls from 9 studies using targeted and whole exome next-generation sequencing. We tested 3 sets: ‘Null alleles’ (nonsense, splice-site, or frameshift); ‘Deleterious (7/7)’ (null and missense annotated as damaging by 7 algorithms); and ‘Deleterious (6/7)’ (null and missense annotated as damaging by at least 6 algorithms). Given the rarity of deleterious mutations, we aggregated these mutations in each gene and tested for an excess or deficit in cases vs . controls. Results: Counts of mutations are provided in Table. Null mutations in LDLR , carried by 1:500 participants, confered a 8-fold increase in CAD risk (P=8х10 -7 ) whereas heterozygosity for a null mutation in ABCG5 (1:650 frequency) was associated with a 3-fold increased risk (P=5х10 -3 ). ‘Deleterious (7/7)’ mutations in LDLR , carried by 1:100 participants, confered a 4-fold increased risk (P=8х10 -17 ) whereas heterozygosity for a ‘Deleterious (7/7)’ mutation in ABCG5 (1:250 frequency) was associated with a 2-fold increased risk (P=2х10 -3 ). Heterozygous null allele carriers at LDLR and ABCG5 had increased LDL-C (P<0.001). Conclusions: Of early CAD cases, 2-3% carry a rare, deleterious mutation at LDLR or ABCG5 associated with increased risk. Although previously reported to cause recessive sitosterolemia, we find that heterozygosity for a null allele at ABCG5 is associated with markedly higher early CAD risk.

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Mendelian randomization analyses reveal mediating factors of the causal effect of height on coronary artery disease

10.1101/2021.12.16.21267869 ◽

2021 ◽

Author(s):

Daniel Hui ◽

Christopher S. Thom ◽

Kimberly Lorenz ◽

Scott M. Damrauer ◽

Themistocles L. Assimes ◽

...

Keyword(s):

Risk Factors ◽

Coronary Artery Disease ◽

Coronary Artery ◽

Lung Function ◽

Mendelian Randomization ◽

Causal Effect ◽

Multivariable Analysis ◽

Inverse Correlation ◽

Artery Disease ◽

Cad Risk

An inverse correlation between stature and risk of coronary artery disease (CAD) has been observed in several epidemiologic studies, and recent Mendelian randomization (MR) experiments have suggested evidence that this association may be causal. However, the extent to which the effect estimated by MR can be explained by established cardiovascular risk factors is unclear, with a recent report suggesting that lung function traits could fully explain the height-CAD effect. To clarify this relationship, we utilized the largest set of genetic instruments for human stature to date, comprising >2,000 genetic variants for height and CAD. In univariable analysis, we confirmed that a one standard deviation decrease in height (~6.5 cm) was associated with a 12.0% increase in the risk of CAD, consistent with previous reports. In multivariable analysis accounting for effects from up to 12 established risk factors, we observed a >3-fold attenuation in the causal effect of height on CAD susceptibility (3.7%, p = 2.1x10-2). We observed minimal effects of lung function traits on CAD risk in our analyses, indicating that these traits are unlikely to explain the residual association between height and CAD risk. In sum, these results suggest that height does not add meaningful clinical impact on CAD risk prediction beyond established risk factors.

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Abstract 5070: Progression of Urine Albumin Excretion Despite of Optimized Therapies to Reduce Atherosclerotic Risk Factors has an Adverse Outcome in Patients with Coronary Artery Disease

Circulation ◽

10.1161/circ.118.suppl_18.s_1139-b ◽

2008 ◽

Vol 118 (suppl_18) ◽

Author(s):

Yoshinobu Kitta ◽

Mitsumasa Hirano ◽

Takamitsu Nakamura ◽

Yasushi Kodama ◽

Keita Sano ◽

...

Keyword(s):

Risk Factors ◽

Coronary Artery Disease ◽

Coronary Artery ◽

Adverse Outcome ◽

Coronary Risk Factors ◽

Urine Albumin Excretion ◽

Albumin Excretion ◽

Urine Albumin ◽

Artery Disease ◽

Cad Risk

Although microalbuminuria is considered a strong risk factor of future cardiovascular disease (CVD), it remains unclear whether changes in urine albumin excretion (UAE) in response to a reduction of coronary risk factors may provide prognostic information in patients with coronary artery disease (CAD). Thus, this study assessed the hypothesis that changes in UAE in response to optimized therapy for reduction of CAD risk may predict future CVD events in patients with CAD. This study enrolled of 213 patients with newly diagnosed CAD who had microalbuminuria (30 mg/day ≤ UAE < 300 mg/day) at entry. Patients with late-stage chronic kidney disease (GFR < 60 ml/min/1.73 m 2 ) at entry were excluded. All patients had individualized, optimized therapies including medications and recommended life style changes to reduce risk factors for CAD according to AHA guidelines. All patients had a repeated test of UAE at 6 months (2 nd test) after the 1 st UAE test. Thereafter, all patients were prospectively followed up for 3 years or until the occurrence of 1 of the following events: CVD death, nonfatal myocardial infarction, unstable angina pectoris requiring revascularization, or ischemic stroke. Progression of UAE at the 2 nd test was defined as > 50% increase from the UAE at the 1 st test. UAE at 2 nd test was progressed in 62 (29%) patients, while it was not progressed in the remaining 151 (71%) patients. UAE at entry was comparable between patients with and without progression of UAE (52 ± 6.2 vs.61 ± 4.7 mg/day, respectively, p = ns). During follow-up period, events occurred in 15 (24%) of the 62 patients with progression of UAE and in 16 (10%) of the 151 patients without progression of UAE (p < 0.01 by chi-square test). Using a multivariate Cox hazards analysis, progression of UAE was a predictor of future CVD events that was independent of UAE at 1 st test, use of medications, age, and traditional CAD risk factors (HR 2.5, 95%CI 1.2 – 4.8, p = 0.01). Progression of urine albumin excretion despite individualized and optimized therapies to reduce CAD risk factors represents an adverse outcome in CAD patients. Periodic measurement of urine albumin excretion may be useful for risk stratification in CAD.

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A new model to implement a structured enhanced education and follow-up program in primary prevention for coronary artery disease

European Heart Journal ◽

10.1093/ehjci/ehaa946.1419 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

O Soran ◽

P.G Karadeniz ◽

I.G Aktas ◽

C.C Genc ◽

M.H Ilkaya ◽

...

Keyword(s):

Risk Factors ◽

Coronary Artery Disease ◽

Coronary Artery ◽

Medical Students ◽

Primary Prevention ◽

Behavioral Outcomes ◽

Prevention Measures ◽

Artery Disease ◽

Cad Risk

Abstract Background Primary prevention programs for coronary artery disease (CAD) may be effective in improving health-related behavioral outcomes. However, the implementation and especially the maintanance of these programs can be very challenging mainly due to staffing cost. Thus, the present study was designed to assess the feasibility and effectiveness of a longitudinally structured, enhanced education and follow-up program for CAD prevention in an area where the diverse population and economy are major problems. Methods SANKO Coronary Artery Disesae Prevention Project (SCAD-PPI) was designed as a longitudinal study and utilized medical school students to conduct the entire project under the supervision of professors. It started in 2014 and had 2 different education and training phases. In the first phase; every school year, 2nd year Medical students underwent a one-year, specially designed training program on primary prevention for CAD. In the second phase, which took place in the 2nd year of the study, a series of conferences on primary prevention for CAD were organized by the University and local municipalities for underserved populations. Participants were prospectively assigned to an intervention where pre and post conference knowledge were collected and assessed. Every intervention was conducted by specially trained 3rd year Medical students and an education booklet which was specifically designed for this study was given to the participants. Every other month thereafter, for 6 months, each participant was followed by phone. At the 6 month follow -up, data was collected to assess the impact of enhanced education and follow-up program on behavioral outcomes. Results A total of 135 participant were enrolled; 79% were women, mean age was 41±13 years, only 29% had a graduate school degree; 56% were not working. Mean BMI was 28.3±5.1kg/m2. Overall knowledge on CAD risk factors, primary prevention measures, diet and daily exercise habits were very poor. After the enhanced education and follow-up program there was a significant improvement on the knowledge of CAD risk factors and primary prevention measures (p<0.001). More importantly, the follow-up program led participants to implement those positive changes into their lives and maintain a healthy life style. A separate cost analysis showed significant savings. Conclusion This is the first study which showed that a longitudinally structured training program of medical students could be utilized to implement an enhanced education and follow–up program for primary prevention of CAD in an economically challenged, underserved population with successful outcomes. This model program is not only cost-effective and beneficial for public interest but also enhances active interaction of medical students with patients at a very early stage of their career. Funding Acknowledgement Type of funding source: None

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Breast artery calcium noted on screening mammography is predictive of high risk coronary calcium in asymptomatic women: a case control study

VASA ◽

10.1024/0301-1526/a000312 ◽

2013 ◽

Vol 42 (6) ◽

pp. 429-433 ◽

Cited By ~ 19

Author(s):

Martin E. Matsumura ◽

Crystal Maksimik ◽

Matthew W. Martinez ◽

Michael Weiss ◽

James Newcomb ◽

...

Keyword(s):

Risk Factors ◽

Coronary Artery Disease ◽

Coronary Artery ◽

High Risk ◽

Coronary Artery Calcium ◽

Screening Mammography ◽

Artery Disease ◽

The Relationship ◽

Asymptomatic Women ◽

Cad Risk

Background: The relationship between breast artery calcification (BAC) noted on mammography and both coronary artery disease and cardiovascular risk remains controversial. Few studies have examined the clinical significance of BAC in asymptomatic women. In the present study we evaluated the relationship between BAC and coronary artery calcium (CAC) as identified by multi-slice CT scanning (MSCT). Patients and methods: Consecutive women (n = 98) with BAC noted on routine mammography but without known coronary artery disease (CAD) were assessed for CAD risk factors and had assessment of coronary calcium by MSCT. A control cohort of consecutive women who were BAC(-) (n = 104) underwent an identical assessment. Results: Women who were BAC(+) were older than those who were BAC(-); otherwise, there were no differences between the 2 groups with regard to traditional cardiac risk factors. Significantly more BAC(+) vs. BAC(-) women were found to have high risk CAC scores, defined as CAC > 400 (11.2 % vs. 1.0 %, p = 0.006). However, the rates of CAC scores of 0 were not different between the two groups (50.0 % vs. 54.8 % for BAC(+) and BAC(-) , respectively, p = 0.586). When examined in a multivariate model including the traditional risk factors of diabetes, increasing age, smoking, hyperlipidemia, and family history of CAD, the presence of BAC remained significantly associated with CAC > 400 (OR = 22.6, 95 % CI = 2.1 - 237.1). Conclusions: The presence of breast artery calcium on screening mammography was a strong independent predictor (odds ratio > 22) of high risk coronary artery calcium scores (defined as CAC > 400). The presence of BAC in those with significant CAD risk factors may warrant further evaluation.

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The Association Between Coronary 18F-Sodium Fluoride Uptake With Pro-Atherosclerosis Factors in Patients With Multivessel Coronary Artery Disease: A Mono-Centric Pilot Study

10.21203/rs.3.rs-568886/v1 ◽

2021 ◽

Author(s):

Wanwan Wen ◽

Mingxin Gao ◽

Mingkai Yun ◽

Jingjing Meng ◽

Ziwei Zhu ◽

...

Keyword(s):

Risk Factors ◽

Coronary Artery Disease ◽

Coronary Artery ◽

Sodium Fluoride ◽

Troponin I ◽

Cardiac Computed Tomography ◽

Serum Biomarkers ◽

Multivessel Coronary Artery Disease ◽

Artery Disease ◽

Cad Risk

Abstract Purpose: 18F-Sodium fluoride (18F-NaF) positron emission tomography (PET) is a novel approach to detect and quantify microcalcification in atherosclerosis. Peri-coronary adipose tissue (PCAT) is associated with vascular inflammation and high-risk atherosclerotic plaque. We aimed to assess the association between coronary 18F-NaF uptake with pro-atherosclerosis factors in patients with multivessel coronary artery disease (CAD) and to explore the systematic vascular osteogenesis in the coronary artery and aorta in these patients. Methods: Patients with multivessel CAD prospectively underwent cardiac computed tomography (CT) and 18F-NaF PET/CT. PCAT density was measured in the coronary artery and the average PCAT value was calculated from the three coronary arteries in each patient. 18F-NaF tissue-to-blood ratios (TBR) in the coronary artery (TBRCoronary) and aorta (TBRAorta) were calculated. Correlations between coronary 18F-NaF uptake with PCAT density, coronary artery calcium (CAC) burden, CAD risk factors, serum biomarkers, and aortic 18F-NaF uptake were evaluated, respectively. Patients were categorized by a median of TBRCoronary 2.49. Results: 100 multivessel CAD patients (64.00 [57.00 - 67.75] years; 76 men) were prospectively recruited. 6010 active aortic segments (TBR ≥ 1.6) were identified. TBRCoronary was significantly associated with the PCAT density (r = 0.56, p < 0.001) and CAC score (r = 0.45, p < 0.001). TBRCoronary was also significantly associated with the TBRAorta (r = 0.42, p < 0.001). In addition, patients with higher TBRCoronary showed elevated PCAT density (-75.89[-79.07 - -70.06] vs -84.54[-90.21 - -79.46]; p < 0.001) and CAC score (1495.20[619.80 - 2225.40] vs 273.75[116.73 - 1198.18]; p < 0.001) in comparsion patients with lower TBRCoronary. TBRCoronary was correlated with the age (r = 0.24, p = 0.019) and the serum troponin I levels (r = 0.22, p = 0.039). There were no significant correlations between TBRCoronary with other conventional CAD risk factors and other serum biomarkers.Conclusion: Coronary 18F-NaF uptake was correlated with the PCAT density. A significant correlation between 18F-NaF uptake in the coronary artery and aorta might indicate a systematic vascular osteogenesis in patients with multivessel CAD.

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Role of inflammation, autotaxin and lipoprotein (a) in degenerative aortic valve stenosis in patients with coronary artery disease

CARDIOVASCULAR THERAPY AND PREVENTION ◽

10.15829/1728-8800-2021-2598 ◽

2021 ◽

Vol 20 (2) ◽

Author(s):

A. L. Burdeynaya ◽

O. I. Afanasyeva ◽

E. A. Klesareva ◽

N. A. Tmoyan ◽

O. A. Razova ◽

...

Keyword(s):

Risk Factors ◽

Coronary Artery Disease ◽

Coronary Artery ◽

Aortic Valve ◽

Aortic Valve Stenosis ◽

Control Group ◽

Lymphocyte Ratio ◽

Group 2 ◽

Artery Disease ◽

Group 1

Aim. To study the relationship between the concentration of lipoprotein (a) (Lp (a)) and autotaxin (ATX) in patients with and without degenerative aortic valve stenosis (AoS) in the presence of coronary artery disease (CAD).Material and methods. The study included 461 patients (mean age, 66±11 years, men, 323), 354 of whom had CAD with stenosis ≥50% in at least one coronary artery according to angiography. Degenerative AoS was diagnosed with ultrasound. The control group consisted of 107 patients without CAD and degenerative AoS. Concentrations of Lp (a), ATX, lipids and blood cells were measured for all patients.Results. CAD without degenerative AoS (group 1) was diagnosed in 307 patients, while 47 patients had CAD and degenerative AoS (group 2). Patients in both groups were older than patients in the control group (66±10, 74±8, and 61±13 years, respectively). The ATX level was lower in group 1 (median [25; 75%]: 495 [406; 583] ng/ml) than in the control group (545 [412; 654] ng/ml) or group 2 (545 [476; 605] ng/ml) (p<0,05 for all). Lp (a) was lower in the control group (14,5 [5,5; 36,0] mg/dl) than in group 1 (24,9 [9,7; 58,4] mg/dl) (p<0,005) and group 2 (23,8 [9,9; 75,7] mg/dL) (p<0,05). According to the logistic regression, an increased ATX level, regardless of age and other risk factors, was associated with degenerative AoS only in patients with CAD, while age and neutrophil to lymphocyte ratio were associated with the development of degenerative AoS both in patients with CAD and the general group.Conclusion. An elevated Lp (a) level is associated with CAD regardless of the aortic valve involvement, while an increased concentration of ATX and neutrophil to lymphocyte ratio in patients with CAD were associated with degenerative AoS regardless of age and other risk factors.

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Prevalence and trends of coronary artery disease risk factors and their effect on age of diagnosis in patients with established coronary artery disease: Tehran Heart Center (2005–2015)

BMC Cardiovascular Disorders ◽

10.1186/s12872-021-02293-y ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Kaveh Hosseini ◽

Seyedeh Hamideh Mortazavi ◽

Saeed Sadeghian ◽

Aryan Ayati ◽

Mahdi Nalini ◽

...

Keyword(s):

Risk Factors ◽

Coronary Artery Disease ◽

Coronary Artery ◽

Density Lipoprotein ◽

Increasing Trend ◽

Age Of Diagnosis ◽

Heart Center ◽

Artery Disease ◽

Cad Risk ◽

Opium Use

Abstract Background Coronary artery disease (CAD) is a universal public health challenge, more prominently so in the low- and middle-income countries. In this study, we aimed to determine prevalence and trends of CAD risk factors in patients with documented CAD and to determine their effects on the age of CAD diagnosis. Materials and methods We conducted a registry-based, serial cross-sectional study using the coronary angiography data bank of the Tehran Heart Center. Adult patients who had obstructive (> 50% stenosis) CAD were included in the study. The prevalence and 11-year trends of conventional CAD risk factors were analyzed by sex and age, and their adjusted effects on the age of CAD diagnosis were calculated. Results From January 2005 to December 2015, data for 90,094 patients were included in this analysis. A total of 61,684 (68.5%) were men and 28,410 (31.5%) were women. Men were younger at diagnosis than women, with a mean age of 60.1 in men and 63.2 in women (p < 0.001), and had fewer risk factors at the time of diagnosis. Mean age at diagnosis had an overall increasing trend during the study period. Increasing trend was seen in body-mass index, hypertension prevalence, diabetes mellitus. All lipid profile components (total cholesterol, low-density lipoprotein cholesterol, triglycerides, and high-density lipoprotein cholesterol) decreased over time. Of particular interest, opium consumption was associated with 2.2 year earlier age of CAD diagnosis. Conclusion The major results of this study (lower age of CAD diagnosis in men, lower age of diagnosis associated with most risk factors, and lower prevalence of serum lipids over time) were expected. A prominent finding of this study is confirming opium use was associated with a much younger age of CAD onset, even after adjusting for all other risk factors. In addition to recommendations for control of the traditional risk factors, spreading information about the potential adverse effect of opium use, which has only recently been associated with higher risk of CAD, may be necessary.

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Unique and Varied Contributions of Traditional CVD Risk Factors: A Systematic Literature Review of CAD Risk Factors in China

Clinical Medicine Insights Cardiology ◽

10.4137/cmc.s10225 ◽

2013 ◽

Vol 7 ◽

pp. CMC.S10225 ◽

Cited By ~ 9

Author(s):

Joanne Foody ◽

Yong Huo ◽

Linong Ji ◽

Dong Zhao ◽

Dylan Boyd ◽

...

Keyword(s):

Risk Factors ◽

Systematic Review ◽

Coronary Artery Disease ◽

Coronary Artery ◽

Real World ◽

Odds Ratio ◽

Lipid Levels ◽

Artery Disease ◽

The Impact ◽

Cad Risk

This study is the first systematic review of risk factors for stroke in China and supports the importance of current public health initiatives to manage the risk factors appropriately to reduce risk of stroke in high risk patients. Additionally, this study has been co-authored by prominent Chinese and US physicians and researchers with expertise in cardiovascular disease, neurologic disorders, epidemiology, and real world data. While there have been several systematic reviews of real world associations of risk factors for coronary artery disease, none focus specifically on the population of China, where there is growing evidence that such risk factors are poorly treated or uncontrolled, especially in rural areas. Background To better understand the impact of traditional cardiovascular risk factors on risk of coronary artery disease (CAD) in China, a systematic review of all Chinese observational studies published in either English or Chinese in MEDLINE and EMBASE over the last 5 years was performed and the association between any of 5 traditional risk factors (ie, hypertension, diabetes, elevated lipid levels, obesity, and smoking) and the risk of CAD was studied. Methods and Results The study found a consistent relationship between lipid levels and CAD. Higher low-density lipoprotein cholesterol values were associated with greater risk of CAD, with an odds ratio as high as 3.31. Other factors found to be significant contributors to the risk of CAD included hypertension (crude odds ratio range of 1.40-5.11), diabetes (1.50-5.97), and smoking (1.37-5.19). An association between obesity and CAD in China was observed, but the evidence supporting this was considered weak due to the paucity of studies found as part of this review. Conclusions This review provides a systematic summary of CAD risk factors in China and demonstrates the important differences that exist in CAD risk factors between countries and regions. Approaches to reduce CAD globally must take into account the unique risk factors that drive CAD in each country and region as is demonstrated by these findings.

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