Korean Circulation Journal

The Korean Society of Cardiology (대한심장학회)
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Impacts of Atherosclerotic Coronary Risk Factors on Atherosclerotic Surrogates in Patients with Coronary Artery Disease

관상동맥 질환에서 동맥경화 위험인자가 동맥경화 지표들에 미치는 영향

Hwang, Won-Min;Bae, Jang-Ho;Kim, Ki-Young;Synn, Yi-Chul
황원민;배장호;김기영;신이철

  • Published : 2005.02.28
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Abstract

Background and Objectives：The carotid intima-media thickness, endothelial function and arterial stiffness have been shown to be parameters of atherosclerosis. We have performed this study to evaluate the impact of atherosclerotic coronary risk factors on several atherosclerotic parameters in patients with coronary artery disease. Subjects and Methods：The study subjects consisted of one hundred and forty (140) consecutive patients (mean age: 61 years, and 85 males), who demonstrated via coronary angiogram more than 50% stenosis in at least 1 major coronary artery. In an overnight fasting state, the carotid intima-media thickness (IMT), and endothelial function (flow-mediated brachial artery dilatation, FMD) were measured by high-resolution ultrasound, and arterial stiffness (pulse wave velocity, PWV) was measured by using a non-invasive pulse wave analyser. Results：The hypertensive group showed more evidence of greater arterial stiffness (aorta; 8.5$\pm$1.0 m/s vs. 7.9$\pm$1.2 m/s, p=0.004, and greater stiffness of the artery of the lower extremity; 9.2$\pm$1.2 m/s vs. 8.7$\pm$1.3 m/s, p=0.010), which was measured by the pulse wave velocity, than that of the normotensive group. The carotid IMT and the endothelial function showed no significant differences between the two groups. Furthermore, these parameters did not show significant differences with other parameters such as diabetes mellitus, smoking, and hyperlipidemia. Multivariate analysis revealed that hypertension and systolic blood pressure were still the independent factors of arterial stiffness, but carotid IMT and endothelial function were not independent factors. Conclusion：Hypertension and systolic blood pressure are the independent factors of arterial stiffness in patients with coronary artery disease (CAD), but this study did not show that carotid IMT and endothelial function made a significant difference in arterial stiffness. However, in this study, other risk factors were not associated with the differences of these parameters.

배경 및 목적：동맥경화의 비관혈적 지표들 중 내피세포기능, 경동맥 내막-중막 두께와 동맥 탄성도 등이 이용되고 있다. 본 연구는 이미 동맥경화가 진행된 관상동맥 질환자에서 이들 동맥경화 지표들에 영향을 미치는 동맥경화 위험인자 및 임상적 특성을 알아보기 위하여 시행하였다.방 법：관상동맥 조영술상 주요 관상동맥 중 1개 이상의 동맥에50%이상의 병변이 있는 140명의 연속적인 환자들을 대상으로 하였다. 대상 환자들의 평균나이는 61세이고, 85명이남자였다. 공복상태에서 대상자들에게 3가지 동맥경화 지표를 모두 측정하였는데, 내피세포 측정은 고해상도 초음파를 이용한 혈류 의존성 상완동맥 이완능으로, 내막-중막 두께는 고해상도 초음파를 이용하여 총경동맥에서 측정하였고,동맥 탄성도 검사는 비침습적 맥파 분석기로 대동맥, 상지,하지의 맥파 전달 속도를 측정하였다.결 과：고혈압군에서 대동맥 및 하지동맥의 탄성도가 정상 혈압군에 비해서 더 경직되어 있었으나(대동맥; 8.5$\pm$1.0 m/svs. 7.9$\pm$1.2 m/s, p=0.004, 하지동맥; 9.2$\pm$1.2 m/s vs.8.7$\pm$1.3 m/s, p=0.010, pulse wave velocity), 총경동맥내막-중막 두께 및 내피세포의 기능에는 통계학적인 차이를 보이지 않았다. 또한, 이 세 가지 동맥경화 지표들은 당뇨병군과 비당뇨병군, 흡연군과 비흡연군, 고지혈증군과 정상지혈군으로 나누어 각각 비교하였을 때, 위험인자 유무에따른 양군간의 차이를 보이지는 않았다. 다변수 분석을 통하여, 고혈압과 수축기 혈압만이 대상 환자군에서 여러 위험인자 중 독립적으로 동맥탄성도에 영향을 주었다.결 론：수축기 혈압과 동맥경화의 위험인자 중 고혈압은 관상동맥 질환이 있는 환자군에서 동맥 탄성도를 감소시키는 독립인자로서 고혈압을 가진 진행된 동맥경화 환자에서 혈압조절이 중요함을 시사 한다.

Keywords

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