Cor Vasa 2009, 51(10):685-690 | DOI: 10.33678/cor.2009.170

The changing spectrum of risk factors for coronary heart disease

Vladimír Staněk^1,*, Renata Cífková², Marie Gebauerová¹, Alena Lorencová³, Rudolf Poledne³, Věra Lánská⁴

¹ Klinika kardiologie

² Pracoviště preventivní kardiologie

³ Laboratoř pro výzkum aterosklerózy

⁴ Oddělení statistiky, Institut klinické a experimentální medicíny, Praha, Česká republika

Aims: The aim of the study was to assess conventional and newer emerging risk factors in cases with acute coronary syndrome (ACS) and in apparently healthy controls selected from a random population sample.

Methods and results: Conventional risk factors for coronary heart disease and anthropometric data were analyzed in a group of 284 men and 50 women below 65 years of age, admitted for non-fatal ACS associated with an increase in cardiospecific enzymes. A control group comprised 794 and 960 men and women of similar age, selected from a Czech random population sample.
Men with ACS were found to have similar levels of total (6.04 ± 1.11 vs 6.09 ± 1.02 mmol/l, NS) and LDL-cholesterol (3.81 ± 1.02 vs 3.93 ± 0.91 mmol/l, NS) and lower levels of HDL-cholesterol (1.16 ± 0.32 vs 1.25 ± 0.33 mmol/l, p < 0.01). Smoking (70.1 % vs 34.1%, p < 0.001) and diabetes (22.5% vs 7.7%, p < 0.001) were more prevalent in the ACS group compared with controls. Men with ACS showed similar BMI (28.2 ± 4.1 vs 29.0 ± 4.4 kg/m², NS), yet bigger waist circumference (102.7 ± 10.3 vs 99.9 ± 11.2 cm, p < 0,001) and smaller hip circumference (98.0 ± 9.6 and 105.0 ± 7.8 cm, p < 0.001). Triglyceride levels, as measured in the acute phase of the disease, did not differ in male patients and controls (1.90 ± 1,26 vs 2.15 ± 1.37 mmol/l, NS). Prevalence of hypertension was lower in male cases than in controls (41.0% vs 55.5%, p < 0,001). Diabetes affected 22.0% of male ACS patients compared with 7.1% of controls (p < 0.001).
In females, the differences between patients and controls were similar. Females with ACS and controls had comparable total (6.29 ± 1.17 vs 6.24 ± 1.13 mmol/l, NS) and LDL-cholesterol (4.05 ± 1.0 vs 4.02 ± 1.0 mmol/l, NS). HDL-cholesterol was lower in the diseased group (1.24 ± 0.34 vs 1.7 ± 0.38 mmol/l, p < 0.001) while triglycerides did not show any difference (1.78 ± 1.00 vs 1.69 ± 0.96 mmol/l, NS). There were more smokers (76.1 % vs 23.5%, p < 0.001) and more diabetics (33.3 % vs 7.2%, p < 0.001) among females with ACS; their waist circumference was bigger (97.1 ± 10.0 vs 90.2 ± 13.2 cm, p < 0.001) and hip circumference smaller (101.0 ± 7.4 vs 108.2 ± 11.2 cm, p < 0.001), BMI did not differ (28.4 ± 5.5 vs 29.2 ± 5.7 kg/m², NS). Similar prevalence rates for hypertension were found in female cases and controls (52.4% vs 48.9%, NS).
After adjustment for hypertension, triglycerides > 1.69 mmol/l, HDL-cholesterol < 1.04 mmol/l and BMI > 30 kg/m²) in males, logistic regression analysis revealed odds ratios of 5.14 for diabetes, 4.06 for waist circumference, 4.96 for smoking, and 1.33 for total cholesterol.

Conclusion: Central obesity in middle-aged Prague residents seems to be a risk factor more powerful than hypertension and increased total and LDL-cholesterol.

Keywords: Acute coronary syndrom; Risk factors for CHD; Central obesity; Metabolic syndrome

Published: October 1, 2009  Show citation