Current options for treatment of chronic coronary artery disease

Prevalence of carotid artery stenosis in Chinese patients with angina pectoris

BACKGROUND

The prevalence of carotid artery stenosis (CAS) in Chinese patients with angina pectoris is unknown.

METHODS

The study population consisted of 989 consecutive patients who were scheduled to undergo nonemergent coronary angiography for suspicion of coronary artery disease (CAD) because of angina pectoris between January 2013 and December 2014. All patients underwent carotid ultrasonography to screen for CAS within one month before or after coronary angiography. We defined cases with 0-50%, 50%-70%, and >70% stenosis as mild, moderate, and severe stenosis, respectively.

RESULTS

CAD was presented in 853 patients (86.2%) of whom 191 patients (19.3%) had 1-vessel disease, 246 patients (24.9%) had 2-vessel disease and 416 patients (42.1%) had 3-vessel disease; left main trunk stenosis present in 137 patients (13.9%). In carotid ultrasonography, the prevalence of mild, moderate, and severe stenosis as well as that of total occlusion of the carotid artery was 54.5%, 13%, 4.7% and 0.8%, respectively. Significant CAS (>50% stenosis and total occlusion) was present in 10.3%, 13.9%, 19.9% and 22.8% of patients with 0-vessel, 1-vessel, 2-vessel and 3-vessel CAD. The severity of CAS was directly correlated (r=0.194, P<0.001) with the extent of CAD. The independent predictors of severe CAS and total carotid artery occlusion were increased age, male sex, hypertension, diabetes mellitus, hyperhomocysteinemia, a previous history of stroke and 3-vessel CAD.

CONCLUSIONS

The prevalence of CAS was not rare in China when compared with that in western countries, and the presence of CAS was weakly correlated with the extent of CAD. Screening for CAS should be recommended in Chinese patients with CAD, especially in those with one or more CAS-associated risk factors.

Association of traditional risk factors with coronary artery disease in nonagenarians: the primary role of hypertension

BACKGROUND

Previous studies have shown different relationships between traditional cardiovascular risk factors for coronary artery disease (CAD) in very elderly people. Although new associations with CAD have been reported, there is also evidence of the possibility of new therapeutic strategies for the treatment or prevention of CAD.

DESIGN

This article retrospectively examines the possible association of traditional cardiovascular risk factors with CAD in very elderly people aged >90 years. This study represents the hypothesis that the elderly aged >90 years have a different cardiovascular profile with respect to CAD than patients <90 years old.

METHODS

Data on all patients aged >90 years who received a cardiac catheterization were collected from hospital charts from the Department of Internal Medicine, Saarland University Medical Center, Germany, within the study period of 2004-2013. The cardiovascular risk profiles were compared in patients aged >90 years with and without CAD after cardiac catheterization.

RESULTS

One hundred and six out of 67,976 (0.2%, mean age 91.6±1.8 years, 40 female [37.7%]; 95% confidence interval [CI]: 0.1-0.2), and out of a total of 114 of the very elderly patients, were found to have CAD. From the results of this study, the author could establish only a causal relationship between hypertension and CAD in very elderly people (P=0.005). At best, this is just an association with a higher risk of CAD in this age group. Several studies with similar outcomes are needed to establish causality.

CONCLUSION

This study could find no link between CAD and traditional risk factors, except for hypertension.