Cardiovascular risk estimation in patients with intraclinic atherosclerosis

Abstract

Introduction: Cardiovascular diseases are currently the leading cause of death in industrialized countries and are expected to become so in emerging countries by 2020. Among these, coronary artery disease (CAD) is the most prevalent manifestation and is associated with high mortality and morbidity. Quantitative assessment of risk is useful for clinical decision making. Several scores have been developed to estimate ischaemic and bleeding risks, with different outcomes and time frames (GRACE, TIMI, Duke). Objectives: Cardiovascular risk assessment in patients with unstable angina pectoris and their stratification for the appropriate management election. Materials and methods: The study was made in the period of december 2010 - april 2011 and included 80 patients with the diagnostic of unstable angina pectoris based on the clinical, electrocardiographic and échocardiographie evaluation. There have been assessed anginal syndromes, factors for cardiovascular risk, hemodynamic parameters at hospital admission, the results of the laboratory investigation. Duke score was calculated by the equation: Score = feature of angina x (1 + frequency of angina outbreaks/24h) + ST/T abnormalities. Depending on the total points, the risk was stratified in 3 groups: low, moderate, high. Results: The mean age of the patients included in the study was 60,72±0,89 years. Most of the patients showed angina pain at the admission. Clinical signs were dyspnoea (93,75%), palpitations (63,75%), presyncope. At the admission, 68,75% of the patients showed high blood pressure. Crucial risk factors were: arterial hypertension (91,25%), overweight/obesity (91,25%), dyslipidemia (38,75%), diabetes mellitus (28,75%). Echocardiographie atherosclerotic changes of aorta and valves were registered in 98,75% of cases. The assessment of Duke score has been established that 2,5% of the patients had low cardiovascular risk, 23,75% - moderate and 73,75% - high risk that correlates with a death rate of over 2% in one year. Patients with high risk were older, they required a longer hospitalization, they had higher blood pressure values and showed more pronounced changes in the lipid metabolism. Conclusions: Most of the patients with unstable angina pectoris have a high risk of cardiovascular events, which correlates with a death rate over 2% per year. Assessment of cardiovascular risk allows choosing of an adequate treatment (drug therapy or revascularization) which would increase the survival rate.