The relationship between cardiovascular risk factors and the localization of coronary atherosclerotic lesions

الملخص EN

Objective : The localization of coronary atherosclerotic lesions in patients with coronary artery disease is important.

We investigated the relationship between individual cardiovascular risk factors and lesion localization in the coronary arteries.

Methods : We studied 660 consecutive patients with suspected or known coronary artery disease who were referred for coronary angiography at the two catheterization laboratories of Aleppo University Hospitals (Aleppo University Hospital and The Universi Hospital of Cardiology and Cardiac Surgery) from January 2011 to July 2011.

We assessed the following cardiovascular risk factors : male gender, smoking, arterial hypertension positive family history, and diabetes.

We evaluated atherosclerotic lesions creating a stenosis ≥ 50 % in the three coronary arteries and lesions creating a stenosis ≥ 30 % in the left main stem.

Results : Of the 660 study patients, 485 (73.48 %) showed at least one coronary artery lesion with a luminal stenosis ≥ 50 %.

There was an association between individual risk factors and the localization of coronary atherosclerotic lesions.

Male gender, and diabetes mellitus were significant predictors of atherosclerotic lesions in the left anterior descending artery (OR = 2.518, p = 0.000, and OR =1.782, p = 0.002, respectively).

Independent predictors of atherosclerotic lesions in the left circumflex artery were male gender, hypertension, and diabetes (OR = 2.071, p = 0.000, OR = 1.430, p = 0.041, and OR = 1.867, p = 0.000, respectively).

Also male gender, diabetes, and hypertension were predictors of atherosclerotic lesions in the right coronary artery RCA (OR = 2.778, p = 0.000, OR = 1.555, p = 0.013, and OR = 1.462, p = 0.031, respectively).

Diabetes and male gender were also significantly associated with lesions in the marginal branches of the left circumflex artery.

Where as the only predictor of lesion in the PDA was the male gender.

Conclusions : Individual cardiovascular risk factors may be associated with the localization of atherosclerotic lesions in the coronary circulation ; we still need further studies to demonstrate this hypothesis.

LCX disease, and 81 %, 56 % and 46 % for those with LAD disease, respectively.

Among patients with 2-vessel disease, cardiac survivals were lower for those with the combination of lesions of the LAD and LCX.

The results of another study that investigated the survival of non-surgically treated patients with 1-vessel CAD were similar.7 The survivals were not significantly different between patients with isolated lesions of the LAD or the LCX, but both were different from the survivals of patients with RCA disease.

Survival in patients in the latter group was only slightly decreased compared with patients with no significant CAD.

That study also examined the outcome in relation to the exact localization of the lesions in the artery.

The prognosis seemed to be better for patients who had a LAD stenosis after the first septal perforator than for those with a stenosis before the first septa l perforator.

On the contrary, in patients with RCA or LCX disease, the survival of patients with proximally obstructed arteries was not lower than the survival of those widistal lesions.

In another study, Emond et al18 investigated whether the number of vessels with proximal atherosclerotic lesions affected prognosis, but this was not found to be the case.

As described above, the localization of the obstructed arterial segments may affect the prognosis of the patient.

Prediction of segmental location of CAD may help for understanding the pathogenetic mechanism of the atherosclerotic process and the clinical benefits of new treatment approaches.

Hypercholesterolemia, smoking, arterial hypertension, diabetes mellitus, family history of CAD, and male gender have been recognized as major risk factors predisposing to the development of CAD.1-5 Although, there are limited data on the relation between the risk factors for CAD and the localization of lesions.

8, 19 Such an association could have potential clinical implications.

The study’s aim was to investigate this relationship in patients with suspected or known CAD who underwent coronary angiography for chest pain investigation.

METHODS Study patients : The study population consisted of 660 consecutive patients with suspected or known.