MINISTRY OF EDUCATION
MINISTRY OF DEFENCE
AND TRAINING
MILITARY MEDICAL UNIVERSITY
NGUYEN THANH XUAN
THE RELATIONSHIP BETWEEN CORONARY ARTERY
LESIONS WITH SOME RISK FACTORS,
INFLAMMATORY MARKERS IN PATIENTS WITH
CHRONIC CORONARY ARTERY DISEASE
Speciality:
Cardiology
Code:
62 72 01 41
SUMMARY OF MEDICAL DOCTORAL THESIS
Ha Noi – 2014
The work was completed at the Military Medical University
Full name of supervisor:
1. Associate Professor. Nguyen Oanh Oanh, MD.PhD
2. Associate Professor. Le Van Dong, MD. PhD.
The Objection 1:
The Objection 2:
The Objection 3:
Can be found the thesis in:
1. National Library
2. The Library of the Military Medicine University
LIST OF WORKS OF RESEARCH HAS PUBLISHED
AUTHOR RELATED TO THE THESIS
1. Nguyễn Thanh Xuân, Nguyễn Oanh Oanh, Lê Văn
Đông, “Nghiên cứu mối liên quan giữa mức độ tổn thương động
mạch vành với một số yếu tố nguy cơ tim mạch”. Tạp chí Y
Dược học Quân sự, Vol 39, N01, tháng 01/2014, tr: 88-93.
2. Nguyễn Thanh Xuân, Nguyễn Oanh Oanh, Đỗ Khắc
Đại, Lê Văn Đông, “Nghiên cứu nồng độ và mối liên quan của
interleukin 6, interleukin 10 với mức độ tổn thương động mạch
vành ở bệnh nhân bệnh động mạch vành mạn tính”. Tạp chí Y
Dược học Quân sự, Vol 39, N02, tháng 02/2014, tr: 222-226.
1
BACKGROUND
Coronary artery disease (CAD) is a common disease in
developed countries, it has trend increasing in developing
countries, including Vietnam. These risk factors include old
age, male gender, smoking, dyslipidemia, hypertension and
diabetes. These factors increase in the blood, they impact on
vascular endothelium and causing endothelial dysfunction, they
activation of inflammatory cells releasing inflammatory
markers. The inflammatory marker activate other inflammatory
cells releasing series of inflammatory markers and cause to
reaction local inflammatory to form atherosclerotic of arterial
wall. In Vietnam there are a number of studies have mentioned
the role of inflammatory markers with rick factors of CAD.
However, no study has specifically mentioned to overall picture
of proinflammatory markers, anti-inflammatory lesions with
coronary atherosclerosis. Therefore, the question is whether
there is relationship between inflammatory markers with
different degree of damage of the coronary arteries, there is a
relationship between risk factors and inflammatory markers in
coronary artery disease? In order to solve this question, study
should be conducted multiple inflammatory markers
(proinflammatory and anti-inflammatory), assessed the
relationship between inflammatory markers and traditional risk
factors in atherosclerotic lesions of coronary arteries. From
which the project "The relationship between coronary artery
lesions with some risk factors, inflammatory markers in patients
with chronic coronary artery disease”. " be done with two
objectives:
2
1) Survey rate and characteristics of some cardiovascular risk
factors, inflammatory markers levels plasma in patients with
chronic coronary artery disease in 103 Military Hospital.
2) Assessment of the relationship between characteristics of
coronary lesions on angiography images with some
cardiovascular risk factors and inflammatory markers.
* The meaning and practice of science topics
Determination characteristics and relationship of these
risk factors, inflammatory markers (IL-2, IL6, IL-8) and antiinflammatory (IL-10). The results of this study are a new
contribution to cardiology practices in cardiology in Vietnam. It
helps clinicians understand more the pathophysiological
mechanisms of atherosclerosis, improve diagnosis, treatment
and prevention of heart disease in general, and coronary artery
disease particularly.
* Structure of the thesis
The thesis has 119 pages, backgroud has 2 pages, conclusion
has 2 pages, recommendation has 1 page. The thesis has 4
chapters: Chapter 1: Overview has 31 pages, chapters 2: object
and methodology study have 20 pages, chapters 3: Results of
study has 30 pages, chapter 4: discussion has 33 pages.
Thesis has 45 tables, 10 pictures, 9 charts and 131 references
(23 Vietnamese, 108 English).
ABBREVIATIONS
AHA: American Heart Association
BMI: Body mass index
CRP: C- Reactive Protein
IL:interleukin
HDL-c: High density lipoprotein cholesterol
LDL-c: Low density lipoprotein cholesterol
TNF: Tumor Necrosis Factor
Th: helper T cell
3
CHAPTER 1: OVERVIEW
1.1.1. The concept of chronic coronary artery disease
Chronic coronary artery disease also known as ischemia
heart muscle disease, coronary insufficiency, coronary
atherosclerotic disease. Divided into two groups: (1) stable
angina is the most common form. (2) Missing local myocardial
quietly.
1.1.2.2. The risk factors of coronary artery disease
Along with the increase of coronary artery disease, the
risk factors of coronary artery disease is detected and a list of
the risk factors are increasing longer.
These risk factors cannot be interference: age, sex,
genetic factors
These risk factors can be changed: hypertension,
dyslipidemia, smoking, obesity, diabetes and insulin resistance
1.2.2. The role of inflammation in atherosclerosis formation
* The role of macrophages in the development of plaque
In patients with high blood cholesterol, LDL-c invasive
and accumulate in arterial endothelium, the metabolic products,
other factors impact to damage destruction vascular endothelial
cell. Macrophages and monocytes migrate to phagocyt debris,
drops cholesterol and transformed into foam cells, trigger
inflammatory reaction and damaging tissue (Goran K Hansson,
2005).
* The role of lymphocytes T and inflammation
In components of atherosclerotic lesion has immune
cells. including T cells, cells rewind, monocytes, macrophages,
mast cells and other leukocyte cells. In this type Th1 cells
secrete proinflammatory cytokines, to activation macrophages
and causing inflammation (Elisabetta Profumo, 2012).
4
* The anti-inflammatory factors
Th2 cells secrete anti-inflammatory cytokines,
inhibition of inflammatory reactions can promote immune to
prevent atherosclerosis. The balance of inflammatory and antiinflammatory cytokines can decide the development of sclerosis
plaques (Frostegard J 1999; Shimizu K, Shichiri M, 2004;
Uyemura K, Demer LL, 1996). Representing the antiinflammatory marker IL (interleukin)-10, growth factors
stimulate β (TGF-β). Larisa (2009), rate IL-6/IL-10 higher in
the group with coronary artery disease have complications of
myocardial infarction than chronic coronary artery disease.
* The relationship between inflammation and the risk
factors
The intrusion of LDL-c, adipose tissue cytokines
including leptin, adiponectin, and resistin. They may damage to
the endothelial cells and activating increased production of
proinflammatory markers and inflammation under the
endothelial layer and formation of atherosclerosis (Antonino
Tuttolomondo, 2010). Several studies showed that the
relationship between traditional risk factors (obesity, smoking,
hypertension, dyslipidemia, increased blood glucose) with
inflammatory markers. They are related, the correlation clinical
significance in atherosclerotic coronary (Raul Altman, 2003).
Mahinda Y (2009), Peter Libby (2002), Ying Yin (2013). The
adjustment of these risk factors can reduce in inflammatory
markers plasma, and reducing complications of coronary artery
disease (Esposito K, 2003; Weihong Tang, 2007).
* Group inflammatory markers: IL-1, IL-2, IL-6, IL-7, IL-8,
IL-15, IL-17, IL-18, TNF-α, GM-CSF, IFN-γ (Enrique Z
Fisman, 2003).
5
* Group anti-inflammatory marker: IL-4, IL-10, IL-11, IL12, Il-13.
1.3. THE STUDIES ABOUT INFLAMATORY MARKER
IN CORONARY ARTERY DISEASE
Tchernof A (2002). Study 61 female patients with
obesity (BMI: 35,6 ± 5 kg/m2), if body weight had reduced
15,6%, CRP plasma level would have reduced 32,3% (from
3,06 ± 0,69 mg/ml to 1,63 ±0,75 mg/ml), p< 0,0001.
Alan D. Simon, M.D (2001). Results showed that
coronary artery disease group have higher IL-2 plasma level
than the group subjects, p <0.05.
Mehdi Hassanzadeh et al (2006). Results showed that
chronic coronary artery disease group have higher IL-6, TNFα plasma level than the group subjects, p <0.05.
Larisa (2009), Results showed that myocardial
infarction group has lower IL-10 plasma level than group
stable angina. There is a negative correlation between IL-6 and
IL-10 plasma level.
Mustafa Aydin (2009), in Turkish, patients with
coronary artery disease have higher TNFα plasma level than
group coronary artery disease, p <0.05.
Thomas B. Martins (2006). Study complexity of 8
cytokines, results showed that there are differences between
coronary artery disease group and the control group, level in
plasma of IL-2 (p <0.05), IL-6 (p <0.001), IL-8 (p> 0, 05), IL10 (p> 0.05), and TNF-α (p> 0.05), IFN-γ (p> 0.05) and CRP
(p> 0.05).
Nguyen Kim Luu (2012), results showed that the
control group has higher IL-10 plasma level and lower TNF-α
plasma level than diabetic patients with obese group (p <0.05) .
6
Le Thi Bich Thuan (2005), there is a positive
correlation between CRP with traditional risk factors such as:
cholesterol, diabetes mellitus, hypertension.
Le Thi Thu Trang, in 2011, results showed that CRP
plasma level (mg/l) and IL-6 plasma level (pg/ml) are higher in
hypertension group than not hypertensive group, p < 0.0001.
Chapter 2:
SUBJECTS AND
RESEARCH METHODOLOGY
2.1. Study subjects: 109 patients, results of coronary
angiography divided into 02 groups.
2.1.1. Group I: 31 patients had stenosis <50% diameter of
coronary artery lumen (control group).
2.1.2.Nhom II: 78 patients had stenosis ≥ 50% diameter of
coronary artery lumen (chronic coronary artery disease group).
1.3. The standard of selecting patients
Patients was hospitalized with chest pain. Patient has a
risk factors: hypertension, dyslipidemia, smoking, overweight,
diabetes, advanced age. Electrocardiography, echocardiography
had images of myocardial ischemia or suspected myocardial
ischemia. Results of coronary angiography had significant
stenosis or stenosis not significant.
2.1.4. Elimination standards
Myocardial infarction during the acute phase, severe
cardiac arrhythmias. Congenital anomalies of coronary arteries,
muscle bridge. Patients have embolismto in CA (blood clots,
air, wale array ...). The system disease have causing
inflammation of coronary arteries (Kawasaki disease, Takayasu,
lupus erythematosus system ...). Coronary artery damage caused
by radiation therapy. Injury or cerebral vascular accident less
than 3 months. Infections, arthritis, patients had to surgical.
7
2.2. Research Methodology
2.2.1. Study design: cross-sectional descriptive and have
comparison with the control group.
2.2.2. The steps taken to select research subjects
Step 1: Clinical examination, making patients records, Who had
been primary diagnosis was chronic coronary artery disease
(stable angina).
Step 2: Biochemical tests, ECG, echocardiography.
Step 3: Selection of study patients.
Step 4: patients are eligible for blood collection, separation and
preservation of plasma samples at 70ºC negative until test.
Step 5: Selective coronary arteriography under the designation.
2.2.4. Subclinical examination methods
* Method perform some biochemical tests
+ Quantification of lipid components: Quantification of
triglyceride, LDL-c plasma level by the method of enzymatic.
Quantification of HDL-c plasma level by the method of
immunofluorescence.
+ The blood glucose levels: by the method of optical enzymatic
(GOD- PAP)
+ Quantification of cytokines levels: conducting tests to detect 8
cytokines by the method of sandwich immunofluorescence
(interferon [INF-γ], IL-2, IL-4, IL-6, IL-8, IL -10, TNF-α, GMCSF). Unit: pg/ml.
+ Quantification of CRP levels: at the Department of
Biochemistry 103 military hospital. Unit: mg/l
2.3. Some standards used in this study
2.3.1. Diagnosis of angina pectoris: Meets three of the
following
8
Characteristics: (1) Substernal chest discomfort of characteristic
quality and duration; (2) Provoked by exertion or emotional
stress; (3) Relieved by rest and/or use nitrat.
2.3.2. Diagnosis of hypertension: According to JNC VII (Joint
National Committee - 2003). Patients had hypertension when
systolic blood pressure ≥ 140 mmHg and diastolic blood
pressure ≥ 90 mmHg.
2.3.3. Diagnosis of overweight: According to BMI applies to
Asians, overweight are calculated BMI ≥ 23 kg/m2.
2.3.4. Diagnosis of diabetes: according to World Health
Organization in 2006: (1) fasting glucose levels (at least 8 hours
after eating) > 7 mmol/L, at least 2 consecutively tests. (2) test
is a blood glucose levels any of the day > 11.1 mmol/L. (3)
blood plasma glucose levels test after drinking 75 grams of
glucose 2 hours ≥ 11.1mmol/L (glucose tolerance test).
2.3.5. Diagnosis of dyslipidemia: according to the Vietnam
Heart Association.
2.3.6. Standard risk stratification of CRP plasma levels for
cardiovascular disease: follow the guidelines of the American
Heart Association 2003: CRP plasma levels <1 mg/l at low risk,
1-3 mg/l at moderate risk, > 3 mg/l at higher risk for
cardiovascular disease.
2.3.7. Electrocardiography: ST segment elevation down to
was ischemic under endothelium, sideways or angling down to
≥ 1 mm and prolonged 0,06-0,08s.
2.3.8. Some other standards
* Diagnosis of arrhythmias: unevenly pulse, electrical cardiac
had arrhythmias with degrees.
* Diagnosis of Heart Failure: according to NYHA
9
* The diagnosis of acute myocardial infarction: chest pain,
electrocardiogram, cardiac enzymes, results of coronary
angiography.
* Diagnostic history of myocardial infarction: ECG had
waveform Q wide and deep. Results of coronary angiography
had images of chronic arterial occlusion and collateral
circulation.
2.3.9. Resutls of coronary angiography
* Patients group with 50-74% diameter stenosis and patients
group with ≥ 75% diameter stenosis.
* Patients with ≥ 50% diameter stenosis in a branch or many
main coronary branches.
* Characteristics of coronary lesion according to the ACC /
AHA 1988: (1) Type A; (2) Type B; (3) Type C.
2.4. Data processing
The data collected were coded and managed by
Microsoft Office Excel software 2003, and data processing
according to medical statistics algorithms, using SPSS 15.0
(Statistical Package for Science software).
10
CHAPTER 3: STUDY RESULTS
3.1. CHARACTERISTICS OF STUDY SUBJECTS
3.1.1. General Characteristics
Table 3.1. Gender and age characteristics of the study subjects
Gender, age
Group I
Group II
(year)
(n=31)
(n=78)
Men
20
64,5%
67
85,9%
p
<0,05
Chronic coronary artery disease group had higher rate of men
than the control group (p <0.05).
3.2. CHARACTERISTICS OF SOME RISK FACTORS,
LEVELS OF INFLAMMATORY MARKER PLASMA IN
STUDY GROUP OBJECTS
Table 3.10. Table 3.11. Ratio of risk factors between chronic
coronary artery disease groups and control groups
Risk factors
Men
Group I
Group II
(n=31)
(n= 78)
p
20
64,5%
67
85,9%
<0,05
BMI (kg/m ) ≥ 23
6
19,4%
45
57,7%
<0,05
Smoking
9
29,0%
43
55,1%
<0,05
Hypertension
14
45,2%
55
70,5%
<0,05
Dyslipidemia
17
54,8%
60
76,9%
<0,05
Diabetes
6
19,4%
33
42,3%
<0,05
≥ 4 risk factors
12
38,7%
62
79,5%
<0,05
2
Chronic coronary artery disease group had higher rate of men,
smoking, hypertension, dyslipidemia, diabetes and combination
of risk factors than the control group (p<0,05).
11
Table 3:14. Inflammatory markers plasma levels between
chronic coronary artery disease groups and control groups
Group I (n=31)
Group II (n= 78)
p
IL-6 pg/ml
3,6 ± 3,3
9,3 ± 13,9
<0,05
IL-10 pg/ml
14,7 ± 42,4
4,3 ± 1,8
<0,05
0,7 ± 0,3
2,5 ± 3,8
<0,01
Marker
IL6/IL10
Chronic coronary artery disease group had higher IL-6 plasma
levels, rate of IL-6/IL-10 and lower IL-10 plasma levels than
control groups p<0,05.
Table 3:15. Point cut Rate of IL-6/IL-10 plasma levels is
suggested to differentiate between chronic coronary artery
disease groups and control groups
AUC
Indicators
(95%
CI)
IL-6/IL-10
0,897
Cut
Se
Sp
point
%
%
0,870
82,05
93,55
p
<0,0001
Table 3:16. Table 3:17. Rate of risk factors between
degree of stenosis moderate and severe stenosis
Risk factors
50 -74%
≥ 75%
(n = 16)
(n = 62)
p
Men
11
68,8%
56
90,3%
< 0,05
Diabetes
3
18,8%
30
48,4%
< 0,05
≥ 4 risk factors
9
56,3%
53
85,5%
< 0,05
Coronary stenosis ≥ 75% diameter group had higher rate of
men, diabetes and combining multiple risk factors than
coronary stenosis 50-74% diameter, p <0.05.
12
Table 3:18. Table 3:19. Rate of risk factors between the groups
narrow one or multiple main coronary branches
YTNC
One branch
Multiple branch
(n=30)
(n=48)
p
age ≥ 60
14
46,7%
35
72,9%
< 0,05
Diabetes
7
23,3%
26
54,2%
< 0,05
≥ 4 risk factors
18
60,0%
44
91,7%
< 0,05
Multiple main coronary branches narrow group had higher rate
age ≥ 60 year, diabetes, combined risk factors than one main
branches narrow group, p<0,05.
Table 3:20. Rate of some risk factors with characteristics
coronary lesions
Type A
Type B
Type C
(n=22) (1)
(n=35) (2)
(n=21) (3)
n
%
n
%
n
%
Smoking
10
45,5
19
54,3
14
66,7
p1-3< 0,05
Diabetes
6
27,3
17
48,6
10
47,6
p1-2,3< 0,05
Risk
factors
p
Type C group had higher rate of smoking, diabetes than type A
group, p<0,05.
Table 3:21. Comparison of inflammatory markers plasma levels
with degree of coronary stenosis
50 -74%
≥ 75%
CRP (mg/l)
2,3 ± 1,7
4,9 ± 5,0
< 0,05
IL-8 (pg/ml)
4,6 ± 2,8
24,6 ± 60,1
< 0,05
Marker
p
Coronary stenosis ≥ 75% diameter group had higher CRP, IL-6
plasma levels than coronary stenosis 50-74% diameter group,
p<0,05.
13
Table 3:22. Ratio increases of inflammatory markers plasma
levels on the severity of coronary stenosis
Value comparison
≥ 75%
50 -74%
p
CRP > 3** (mg/l)
3
18,8%
33
53,2% <0,05
IL-2 ≥ 1,3* (pg/ml)
0
0,0%
16
25,8% <0,05
IL-6 ≥ 3,6 * (pg/ml)
3
18,8%
53
85,5% <0,01
* Value compared with the average value of inflammatory markers plasma levels of
coronary stenosis group < 50% diameter. ** The value of CRP plasma levels at high
risk for cardiovascular disease.
Coronary stenosis severity group had higher rates increases of
CRP, IL-2, IL-6 plasma levels moderate narrow group, p <0.05.
Table 3:25. Ratio increases of inflammatory markers plasma
levels according to number branch lesions
Value comparison
IL-2 ≥ 1,3*(pg/ml)
One
Multiple
(n=30)
(n=48)
2
6,7%
14
29,2%
p
p<0,05
Multiple main coronary branches narrow group had higher IL-2
plasma levels than one coronary branches narrow, p<0,05.
Table 3:26. Table 3:27. Comparison of inflammatory markers
plasma levels of according to coronary lesions types(pg / ml)
Markers
IL-6
IL-6 ≥
3,6 *
Type A
Type B
Type C
(n=22)
(n=35)
(n=21)
4,4±2,8
10,6±18,2
12,1±11,7
p1-3<0,05
100
p1-2<0,05
%
p1,2-3<0,05
9
40,9
%
26
74,3
%
21
p
* Value compared with the average value of inflammatory markers plasma levels of
coronary stenosis group < 50% diameter.
14
Type C coronary lesions group had higher IL-6 plasma levels
and rates increasing of IL-6 plasma levels than type A
(p <0.05).
3.3.3.
The
relationship
between
risk
factors
with
inflammatory markers plasma levels in the chronic
coronary artery disease group
Table 3:30. Relationship between inflammatory markers plasma
levels with smoking group
Markers
IL- 8 (pg/ml)
No smoke
Smoking
(n= 35)
(n= 43)
X ± SD
X ± SD
7,3 ± 11,0
31,2 ± 70,8
p
<0,05
Smoking group had higher IL-8 plasma levels than no smoke
group, p <0.05.
Table 3:32. Ratio increases of inflammatory markers levels
with overweight group (kg/m2 )
Markers
IL-6 ≥ 3,6* pg/ml
BMI < 23
BMI ≥ 23
(n=33)
(n=45)
16
48,5%
33
73,3%
p
<0,05
* Value compared with the average value of inflammatory markers plasma levels of
coronary stenosis group < 50% diameter
Patients with overweight had higher rate increases of IL-6
plasma levels than patients with BMI < 23 kg/m2, p < 0.05.
15
Bảng 3.34. Ratio increases of inflamatory markers plasma
levels with hypertension group
Markers
No hypertension
Hypertension
(n=23)
(n=55)
p
IL-2 ≥ 1,3 pg/ml
1
4,3%
15
27,3%
<0,05
IL-6 ≥ 3,6 pg/ml
13
56,5%
43
78,2%
<0,05
Hypertention group had higher rates increases of IL-2, IL-6
plasma level than no hypertention group, p< 0,05.
Bảng 3.36. Ratio increase of inflamatory marker plasma levels
with diabetes mellitus group
Markers
TNF-α ≥ 1,8pg/ml
No diabetes
Diabetes
(n=45)
(n=33)
16
p
35,6% 21 63,6% <0,05
Diabetes mellitus group had hihger rates increase of TNF-α
plasma levels than no diabetes, p< 0,05.
Table 3:37. Table 3:38. Relationship between inflammatory
markersplasma levels with dyslipidemia group
No
Marker viêm
dyslipidemia
Dyslipidemia
(n=60)
(n=18)
IL- 8 pg/ml
*
IL-6 ≥ 3,6 pg/ml
6,4 ± 6,4
8
44,4%
p
24,7 ± 61,1
<0,05
43
<0,05
71,7%
* Value compared with the average value of inflammatory markers plasma levels of
coronary stenosis group < 50% diameter
Dyslipidemia group had higher IL-8 plasma levels and rate
increases IL-6 plasma levels than no dyslipidemia group,
p<0,05.
16
DISCUSSION
4.1.1. Gender and age characteristics of the study subjects
Study had 109 patients, including 87 patients with coronary
artery disease, 31 patients with the control group (coronary
artery stenosis is not significantly through selective coronary
angiography). Patients with chronic coronary artery disease had
higher rate of male than the control group (85.90%; 64.52%, p
<0.05), no significant differences were found between CAD and
the control group with age (Table 3.1). This result are similar
with the results of other authors. Do Thi Thu Ha (2010), the
CAD had rate of men accounted for 75.3%. Pham Vu Thu Ha
(2012), males 75.3%, females 24.7%. Radoslaw Krecki (2010),
patients with CAD had higher rate of men than the control
group (74%, 53%, p <0.05).
4.2.1. Characteristics of some risk factors in the study group
The study results showed that the chronic CAD group
had higher rate of risk factors than the control group: males
(85.9%, 64.5%), hypertension (70.5%, 45.2%), smoking
(55.13%, 29.03%), dyslipidemia (76.9%, 54.8%), overweight
(57.69%, 19.4%), diabetes (42.3%, 19.4%) (p < 0.05) (Table
3.10), combined least 4 risk factors (79.5% versus 38.7%) (p
<0.0001) (Table 3.11). This results are similar to other studies,
Jennifer K. Pai (2004), K Tanaka (2001), Michael Miller
(2011), Paul M. Ridker (2000), Thomas B. Martins (2006),
Vladimira Muzakova (2010).
4.2.2. Characteristics of inflammatory markers in the study
group
17
In the study, patients with chronic CAD had higher
inflammatory markers plasma levels than the control group:
IL-6 (13.9 ± 9.3 pg/ml; 3.6 ± 3.3 pg/ml), ratio of IL-6/IL-10
plasma levels (2.5 ± 3.8; 0.7 ± 0.3). However patients with
chronic CAD had lower IL-10 plasma levels than the control
group (4.3 ± 1.8 pg/ml; 14.7 ± 42.4 pg/ml), p <0.05 (table 3.14).
Le Thi Bich Thuan (2005), Barbara J.M.H. Jefferis (2011). Hem
C. Jha (2010), Santanu Biswas (2010), Thomas B. Martins
(2006).
4.3.1. Relationship between the degree of coronary artery
lesions with some cardiovascular risk factors
* Hypertension: Ratio of hypertension patients in severity of
coronary artery stenosis (74.2%), multiple coronary artery
stenosis (77.1%) and type B lesions (80.0%) were higher than in
moderate of coronary artery stenosis (56.3%), one coronary
artery stenosis (60.0%), type A lesions (59.1%). However, no
significant difference were found (p > 0.05; table 3.16, 3.18
table; table 3.20). Similar to the results of the author James
S.Zebrack (2002), K Nakajima (2004).
* Dyslipidemia: Ratio of dyslipidemia patients in severity of
coronary artery stenosis (79.0%) and multiple coronary artery
stenosis (81.3%) were higher than moderate of coronary artery
stenosis (68.8%), one coronary artery stenosis (70.0%) (p>
0.05; table 3.16, 3.18 table). The results of other studies, gotto
AM (1977), Basil N. Saeed (2011), Gösta (1986), Radoslaw
Krecki (2010), Yasar Kucukardali (2008).
* Diabetes: Ratio of diabetes in severity of coronary artery
stenosis (48.4%), multiple coronary artery stenosis (54.2%),
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