The association of the total cardiovascular risk and non-invasive markers of atherosclerosis with the extent of coronary artery disease

Transcription

1 The association of the total cardiovascular risk and non-invasive markers of atherosclerosis with the extent of coronary artery disease S. Kostic 1, D. Mijalkovic 1, D. Djordjevic 2, T. Savic 2, D. Lovic 3, IS. Tasic 2 (1) Institute for Therapy & Rehabilitation "Niska Banja", Niska Banja, Nis, Serbia (2) University of Nis, Medical Faculty, Nis, Serbia (3) Clinic for internal disease InterMedica-dr Lovic, Nis, Serbia

2 The association of the total cardiovascular risk and non-invasive markers of Carotid artery intima-media thickness (CIMT) and the ankle brachial pressure index (ABI) are non-invasive markers of atherosclerosis and have been shown to reliably predict presence and extent of atherosclerotic vascular disease. Ankle-brachial index and carotid intima-media thickness allow the detection of a subgroup of patients at a particularly high level of cardiovascular (CV) risk. The SCORE system estimates the 10-year risk of a first fatal atherosclerotic event, whether heart attack, stroke, aneurysm of the aorta or other. In general, a middle aged person with a 10year of CVD risk of 5% or more is regarded as at high risk.

3 Purpose: The aim of study was to determine the association of the total CV risk estimated with the SCORE model and non-invasive markers of atherosclerosis with the number of coronary blood vessels affected by atherosclerosis.

4 Methods: Examination encompassed 100 patients with coronary disease (45 women and 55 men, mean age 59.7± 10 years) who were in a rehabilitation at the Institute for Treatment and Rehabilitation "Niška Banja". For all patients there was determined: the 10- year absolute risk of fatal CV event according to SCORE system, laboratory analyses and anthropometric measurements, ABI evaluation, ultrasound imaging for CIMT measurement of carotid arteries and coronarography.

5 The number of the coronary vessels with stenosis >70% The association of the total cardiovascular risk and non-invasive markers of Results: The extent of the coronary artery disease was marked as 0, 1, 2, or 3 according to the number of the coronary vessels with narrowing. Most patients, 42.0% had stenosis marked greater than 70% in one coronary vessel; 34.0% in two vessels; 18.0% in three vessels. 42,0% 34,0% 6,0% 18,0%

6 Patients with one blood vessel affected by atherosclerosis were statistically significantly younger than those with three affected blood vessels and their SCORE CVD risk was significantly smaller than at patients with two and three affected blood vessels. Number affected coronary blood vessels One (n=24) Two (n=30) Three (n=46) p value Age 53,88±10,68 59,43±10,87 63,00±8,75 Men 10 (41,7%) 15 (50,0%) 30 (65,2%) Women 14 (58,3%) 15 (50,0%) 16 (34,8%) SCORE 3,17±1,81 6,53±3,63 8,37±5,80 I vs III: p=0,001 n.s. I vs II: p=0,021 I vs III: p<0,001 Average number of risk factors 2,29±1,00 2,97±0,89 2,93±1,06 I vs II: p=0,040 I vs III: p=0,032

7 Evaluation of the association of risk factors of interest with the SCORE CV risk: univariate regression analysis Univariant regression analysis confirmed significant correlation of the risk SCORE with the amount of affected coronary blood vessels and the amount of coronary blood vessels with stenosis greater than 70%. Factor B SE r t p Upper Limits of 95% CI for B Lower ABI -7,707 2,208-0,332 3,49 0,001-12,089-3,325 ABI 0,90 2,837 0,964 0,285 2,94 0,004 0,924 4,750 ABI 0,91-1,29-1,545 0,994-0,155 1,56 0,123-3,517 0,427 ABI 1,30-2,118 1,270-0,166 1,67 0,099-4,638 0,402 CIMT (mm) 4,893 2,428 0,199 2,02 0,047 0,073 9,712 Percentage of stenosis of the carotids 0,048 0,023 0,205 2,08 0,040 0,002 0,094 of plaques 0,723 0,323 0,221 2,24 0,027 0,083 1,363 The number of coronary blood vessels 2,524 0,557 0,416 4,53 <0,001 1,418 3,630 The number of coronary blood vessels with stenosis of over 70% 2,147 0,545 0,369 3,94 <0,001 1,065 3,229 Female gender -3,137 0,943-0,319 3,33 0,001-5,008-1,267 Age (years) 0,260 0,040 0,552 6,55 <0,001 0,181 0,339 BMI (kg/m 2 ) -0,127 0,120-0,107 1,06 0,291-0,365 0,110 Waist circumference (cm) 0,018 0,044 0,042 0,42 0,676-0,069 0,106 Waist-hip ratio 13,939 6,586 0,209 2,12 0,037 0,869 27,009 ABI ankle-brachial index; CIMT carotid intima-media thickness; BMI body mass index

8 Results of the ABI measurement The average value of ABI was 1.02±0.21. Forty-one percent patients had reduced ABI value (<0.9), and 18.0% of them had higher values (>1.3). ABI Experimental group (n=100) 0,90 41 (41,0%) 0,91-1,29 41 (41,0%) 1,30 18 (18,0%)

9 The value of the ABI in patients with three affected coronary vessels was the lowest (0.95±0.2) and significantly lower than in those with only one affected coronary vessel (1.12±0.2, p<0.01). Parameter One (n=24) of affected blood vessels Two (n=30) Three (n=46) Comparison (p value) Xsr SD Median Minimum I vs III: p=0.002 Maximum

10 Color Doppler sonography of the carotid arteries The average value of carotid IMT was 0,98±0,21. The value of the CIMT in patients with three affected coronary vessels was the highest (1,02±0,18) and significantly higher than in those with only one affected coronary vessel (0,86±0,20, p=0,002). Also, they had a higher average number of carotid plaques.

11 Comparison of Doppler characteristics in the carotids of the affected related to the number of affected coronary blood vesels Characteristic of affected blood vessels One (n=24) Two (n=30) Three (n=46) CIMT(mm) 0.86± ± ±0.18 Percentage of stenosis 27.33± ± ±19.20 Comparison (p value) I vs II: p=0.006 I vs III: p=0.002 n.s. Plaque properties No plaques 6 (25.0%) 6 (20.0%) 4 (8.7%) n.s. Fibrous 14 (58.3%) 14 (46.7%) 22 (47.8%) n.s. Calcified 3 (12.5%) 4 (13.3%) 3 (6.5%) n.s. Fibrocalcified 1 (4.2%) 6 (20.0%) 15 (32.6%) I vs III: p=0.007 Fibrolipid (4.3%) n.s. Average number of plaques 1.46± ± ±1,53 I vs III: p=0.022

12 Univariate regression analysis confirmed a significant correlation of the number of atherosclerosis-affected coronary blood vessels with ABI value, IMC thickness, number of plaques, CV risk score, gender, age, and waist-hip ratio. As the most important factors associated with the number of coronary blood vessels affected by atherosclerosis, multivariate regression analysis singled out ABI value, IMC thickness, fibrocalcified plaque type, CV risk score, and waisthip ratio.

13 Evaluation of the association of investigated parameters and the number of affected coronary blood vessels: results of mutivariate regression analysis Factor B SE r t p Upper Limits of 95% CI for B Upper ABI -0,844 0,339-0,221 2,50 0,014-1,516-0,172 CIMT (mm) 0,729 0,351 0,180 2,08 0,040 0,033 1,426 Fibrocalcified plaque type 0,295 0,174 0,152 1,70 0,092-0,050 0,640 CV risk score 0,033 0,016 0,203 2,16 0,033 0,003 0,064 Waist-hip ratio 3,182 0,941 0,290 3,38 0,001 1,313 5,051 Regression constant -0,890 0,980 0,91 0,366-2,836 1,056

14 When the multivariate regression analysis implement the influence of age, gender, hyperlipoproteinemia and diabetes mellitus, important factors associated with the number of affected coronary blood vessels are ABI values, CIMT and relations waist /hip.

15 Evaluation of the association of investigated parameters and the number of affected coronary blood vessels with the control for impacts of age, gender, hyperlipoproteinemia and diabetes Factor B SE r t p Limits of 95% CI for B Upper Upper ABI -0,823 0,339-0,215 2,43 0,017-1,497-0,149 CIMT (mm) 0,670 0,366 0,166 1,83 0,071-0,058 1,397 Fibrocalcified plaque type 0,230 0,182 0,118 1,27 0,208-0,131 0,592 CV risk score 0,021 0,020 0,130 1,09 0,278-0,017 0,060 Waist-hip ratio 2,913 0,966 0,265 3,02 0,003 0,994 4,832 Age (years) 0,008 0,009 0,097 0,82 0,413-0,011 0,026 Gender -0,194 0,163-0,119 1,19 0,238-0,517 0,130

16 Conclusion: Patients with one blood vessel affected by atherosclerosis were significantly younger, their SCORE CV risk and CIMT was significantly smaller but ABI was larger than those with three affected blood vessels. Our results demonstrated a significant association of pathologic changes in the peripheral with those in coronary blood vessels. It was shown that reduced ABI value and CIMT were in correlation with the severity of coronary disease assessed based on the number of affected coronary blood vessels.