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Cardiovascular risk stratification in elderly men with coronary heart disease

Abstract

Aim. To assess cardiovascular risk in elderly patients with coronary heart disease (CHD), in regard to myocardial structure and function, myocardial electrical activity, myocardial repolarisation heterogeneity, metabolic, immune and traditional risk factors (RFs).

Material and methods. In total, 526 people aged 18-92 years were examined, including 167 elderly men with CHD (mean age 75,4 years) as the main group (MG), and 113 healthy men aged 18-65 years as the control group (CG). The MG participants were followed up for 10 years; CHD clinical course and fatal outcomes were monitored. The examination included the assessment of lipid profile (LP), apolipoprotein metabolism, coagulation and acute phase reaction parameters, humoral and cell immunity factors, myocardial electrical activity, ventricular activation velocity, myocardial electrical remodelling, repolarization parameters and their dispersion, as well as myocardial structure and function according to two-dimension echocardiography data.

Results. In univariate analysis, significant predictors of cardiovascular death among the MG patients during 10-year follow-up period were: arterial hypertension (AH), low physical activity, high-density lipoprotein (HDL), apoAI, and apoB cholesterol (CH); increased left ventricular (LV) end-systolic and end-diastolic volume; increased LV myocardial mass; eccentric myocardial remodelling; reduced ejection fraction; terminal stage of electrical myocardial remodelling; increased QLend dispersion; increased blood phagocyte activity. In the MG individuals, the 10-year risk of cardiovascular death was significantly predicted by AH, chronic heart failure functional class, HDL-CH, QLend dispersion and terminal stage of myocardial electrical remodelling.

Conclusion. In elderly CHD male patients, high-risk factors included AH, heart failure, HDL-CH, QLend dispersion and terminal stage of myocardial electrical remodelling. These factors should be considered in risk stratification while predicting 10-year cardiovascular risk.

About the Authors

E. G. Volkova
Ural State Medical Academy of Post-Diploma Education. Chelyablnsk
Russian Federation


I. V. Tantsyreva
Ural State Medical Academy of Post-Diploma Education. Chelyablnsk
Russian Federation


References

1. Беленков Ю.Н., Мареев В.Ю., Агеев Ф.Т. Эпидемиологические исследования сердечной недостаточности: состояние вопроса. Журнал сердечная недостаточность 2002; 3 (2): 57-8.

2. Оганов Р.Г., Масленникова Г.Я. Вклад сердечно-сосудистых и других неинфекционных заболеваний в здоровье населения России. Сердце 2000; 2 (2): 58-61.

3. Фомин И.В., Мареев В.Ю., Щербинина Е.В. Показатели распространенности сердечной недостаточности и эффективности ее терапии в зависимости от тяжести заболевания. Серд недостат 2002; 3(2): 69-70.

4. Беленков Ю.Н. Хроническая сердечная недостаточность в России -опыт 25 лет: где мы находимся и куда должны идти? Серд недостат 2003; 4(1): 9-11.

5. Yusuf S. INTER-HEART: a study of risk factors for first myocardial infarction in 52 countries and over 27000 subjects. Paper presented at the European Society for Cardiology Congress 2004, 29 August-1 September, Munich, Germany. Summary prepared by Murphy M.S.A.

6. Серова Л.Д., Силина З.Д., Кочеткова Л.П. и др. Причины смертности населения пожилого и старческого возраста. Геронт гериат 2003; 2: 14-5.

7. Глезер М.Г Успехи в лечении сердечно-сосудистых заболеваний у пожилых. Клин геронт 2005; 11: 3-8.

8. Manolio TA, Pearson TA, Wenger NK, et al. Cholesterol and heart disease in older persons and women. Review of an NHLBI workshop. Ann Epidemiol 1992; 2: 161-76.

9. Kronmal RA, Cain KC, Ye Z, Omenn GS. Total serum cholesterol levels and mortality risk as a function of age. A report based on the Framingham data. Arch Intern Med 1993; 153: 1065-73.

10. Krumholz HM, Seeman TE, Merrill SS, et al. Lack of association between cholesterol and coronary heart disease mortality and morbidity and all-cause mortality in persons older than 70 years. JAMA 1994; 272: 1335-40.

11. Harris T, Feidman JJ, Kleinman JC, et al. The low cholesterol-mortality association in a national cohort. J Clin Epidemiol 1992; 45: 595-601.

12. Волкова Э.Г Электрическое ремоделирование миокарда -общая закономерность взаимосвязи и сохранения энергии сердца. Новые технологии профилактики, диагностики и лечения в клинике внутренних болезней: Материалы научно-практической конференции кафедры терапии, функциональной диагностики и профилактической медицины УГМАДО. Челябинск 1998; 3: 10-2.

13. Волкова Э.Г. Ранняя диагностика и прогнозирование ишемической болезни сердца. Челябинск 2003; 32.

14. Rich MW. Heart failure in the elderly: strategies to optimize outpatient control and reduce hospitalizations. Am J Geriatr Cardiol 2003; 12(1): 19-27.

15. Sander GE. High blood pressure in the geriatric population: treatment consideration. Am J Geriatr Cardiol 2002; 11(3): 223-32.

16. The Seventh Report of the Joint National Committee on Prevention, Detection and Evaluation and Treatment of High Blood Pressure. JAMA 2003; 289: 2560-72.

17. Tresch DD, Alla HR. Diagnosis and management of myocardial ischemia (angina) in the elderly patient. Am J Geriatr Cardiol 2001; 10(6): 337-44.

18. Leotta G, Maule S, Rabbia F, et al. Relationship between QT interval and cardiovascular risk factors in healthy young subjects. 2005; 19(8): 623-7.

19. Furman NV, Dovgalevskii PIa, Morozov IA Dynamics of corrected QT interval and heart rate in patients with early postinfarction angina: Klin Med 2005; 83(2): 22-4.

20. Sheehan J, Perry IJ, Reilly M, et al. QT dispersion, QT maximum and risk of cardiac death in the Caerphilly Heart Study. 2004;11(1): 63-8.


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For citations:


Volkova E.G., Tantsyreva I.V. Cardiovascular risk stratification in elderly men with coronary heart disease. Cardiovascular Therapy and Prevention. 2008;7(8):45-50. (In Russ.)

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ISSN 1728-8800 (Print)
ISSN 2619-0125 (Online)