Circulation, Vol 89, 1974-1981, Copyright © 1994 by American Heart Association
XL Wang, C Tam, RM McCredie and DE Wilcken
BACKGROUND: Factors predicting the occurrence of premature coronary artery
disease (CAD) may not be quantitatively the same as those predicting CAD
severity, particularly in women, in whom there have been few studies.
METHODS AND RESULTS: To determine factors predictive of severity of CAD and
of angina pectoris, we documented atherogenic variables and the extent of
CAD at angiography in 594 consecutively studied men and women aged 65 years
or less. Severity was assessed from the number of involved major coronary
arteries with significant (> 50%) luminal obstructions and from a
coronary disease severity score. We related severity to quantitative and
categorical atherogenic variables and assessed severity of angina (no
angina, stable angina, or unstable angina) at the time of study in the same
way. There were eight variables independently predictive of severity: in
descending order of relative importance, male gender, diabetes, smoking
dose, ratio of total cholesterol to high-density lipoprotein cholesterol
(TC/HDL-C), lipoprotein(a) [Lp(a)], age, positive family history, and
hypertension. These correctly classified 43.3% of patients into no-, one-,
two-, and three-vessel disease categories and accounted for 25.8% of
variance of severity. Among 246 patients not taking lipid-lowering or
beta-blocking drugs, these variables (in slightly different order)
correctly classified 49.2% of patients and accounted for 36% of the
variance. Among men (n = 427), seven significant variables correctly
classified 39.3% of patients compared with 54.5% in women (n = 167). For
those not taking the above drugs, these proportions were 49.4% and 65.4%,
respectively. Among the quantitative variables, total smoking dose was the
most predictive independent variable irrespective of current or ex- smoking
habit and was more predictive in women than in men; of the lipid variables,
high TC/HDL-C (or low HDL-C) and high Lp(a) were consistently highly
predictive for all patients and in the subgroup analyses. Patients with
unstable angina had higher coronary severity scores and Lp(a) levels and
were more likely to have diabetes, hypertension, or a positive family
history. CONCLUSIONS: We conclude that the quantitative variables most
relevant to severity of premature CAD and to its prevention in Australian
men and women are total amount of lifetime smoking, TC/HDL-C (or HDL-C),
and Lp(a) and that patients with unstable versus stable angina usually have
more severe disease and higher Lp(a).
ARTICLES
Determinants of severity of coronary artery disease in Australian men and women
Department of Cardiovascular Medicine, University of New South Wales, Prince Henry/Prince of Wales Hospitals, Sydney, Australia.
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