Cor Vasa 2017, 59(2):e119-e127 | DOI: 10.1016/j.crvasa.2016.11.013

The risk profile of patients with acute coronary syndrome treated at IKEM between 2006 and 2013

Vladimír Staněk^a,*, Marie Gebauerová^a, Jan Piťha^b, Rudolf Poledne^b, Věra Lánská^c, Renáta Cífková^d, Jolana Mrázková^b, Jiří Kettner^a

^a Klinika kardiologie, Institut klinické a experimentální medicíny, Praha, Česká republika

^b Laboratoř pro výzkum aterosklerózy, Institut klinické a experimentální medicíny, Praha, Česká republika

^c Oddělení biostatistiky, Institut klinické a experimentální medicíny, Praha, Česká republika

^d Centrum kardiovaskulární prevence, 1. lékařská fakulta Univerzity Karlovy a Thomayerova nemocnice, Praha, Česká republika

The proportion and, possibly, also the relevance of some cardiovascular risk factors at the population level are changing. The aim of the present study was to characterize the current risk profile of patients with acute coronary syndrome (ACS) and to compare their data with those obtained from an identical population.
Included in the study were 946 men aged 28-65 years and 296 women aged 30-70 years, admitted to the Department of Cardiology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic, with the diagnosis of ACS between 2006 and 2013. The incidence of risk factors in patients was compared with that identified in an age-matched population sample examined within Czech post-MONICA, a survey conducted in the 2006-2009 period.
Compared with a control group of 1400 men and 1016 women, all risk factors except for total cholesterol were more frequently present in the patients. Men and women with ACS showed similar total cholesterol levels (men 5.41 ± 1.16 mmol/l vs 5.50 ± 1.08 mmol/l; NS; women 5.60 ± 1.25 mmol/l vs 5.71 ± 1.01 mmol/l; NS; respectively), but higher LDL-cholesterol (LDLc) levels (men 3.66 ± 1.05 mmol/l vs 3.38 ± 0.93 mmol/l; p < 0.001; women 3.67 ± 1.17 mmol/l vs 3.45 ± 0.91 mmol/l; p < 0.001, respectively) and lower HDL-cholesterol (HDLc) levels (men 1.14 ± 0.31 mmol/l vs 1.28 ± 0.34 mmol/l; p < 0.001; women 1.32 ± 0.37 mmol/l vs 1.60 ± 0.38 mmol/l; p < 0.001, respectively). These differences persisted even after excluding patients and controls on statin therapy. A more detailed analysis of the lipid profile by age groups revealed bigger differences between patients and controls in LDLc levels (particularly in younger patients), whereas HDLc levels were low in all age groups. Thus, the LDLc/HDLc ratio remains higher in patients than in controls irrespective of age.
A positive family history of premature ACS was likewise present more often in patients (men 19.8% vs 13.9%; p < 0.001; women 25.9% vs 18.4%; p < 0.001), with the differences being bigger in younger patients. In patients with a positive family history, ACS manifested itself at a younger age; the differences between age groups became more marked in cases where a positive family history was associated with smoking or hypertension. Men with ACS and a positive family history differed from the other patients only in a higher proportion of those with low (< 1.0 mmol/l) HDLc (55.5 vs 45.0 %; p < 0.05 mmol/l) and higher body mass index (BMI) (29.27 ± 4.79 vs 28.49 ± 4.29 kg/m2; p < 0.05).
At present, total cholesterol levels do not seem to be a risk factor for ACS in the general population. The risk seems to be highest in smokers and those with low LDLc and/or increased LDLc/HDLc ratio. In younger patients, additional risk factors include a positive family history of premature coronary heart disease (CHD) and higher LDLc levels.

Keywords: Acute coronary syndrome; Age groups; Lipids; Traditional risk factors of CHD

Received: September 29, 2016; Accepted: November 29, 2016; Published: April 1, 2017  Show citation