Factors influencing the appearance of major adverse cardiovascular events after hospitalization for acute coronary disease

Abstract

Despite preventive efforts, coronary artery disease (CAD) remains the leading cause of death in developed countries and a major cause of disability. After the diagnosis of acute CAD, cardiovascular complications are frequent despite the best therapeutic interventions. Apart from the obvious causes, such as poor adherence to therapy or disease severity, little is known about the clinical, laboratory and genetic factors that are associated with late vascular complications. Objective: In this study we intend to evaluate the traditional, clinical, biochemical and genetic factors that can predict vascular complications after the diagnosis of CAD in a Portuguese population. Material and methods: The study included 1090 coronary patients (855 men and 235 women, mean age 53.1 ±7.9 years) consecutively admitted in a cardiology unit. After a mean follow-up of 3 years and 9 months, all patients were interviewed and the clinical history, as well as all the major adverse cardiovascular events (MACE), were reviewed. Patients with MACE (myocardial infarction, stroke, heart failure, need for new angioplasty or surgery and cardiovascular death) were compared with those without MACE. Univariate analysis and multivariate logistic regression analysis were performed. SPSS for Windows version 19.0 was used and a threshold of p<0.05 was accepted as significant. Results: After the follow-up period, 31% of patients developed at least one cardiovascular complication. Comparing patients with and without MACE, significant differences were found in sedentary life (OR=1.94, p<0.0001), leukocytosis (p=0.004), Lp(a) (p=0.01), ApoB (p=0.001) and glucose levels (p=0.02). In genetic terms, HNF4A CC genotype (OR=1.50; p=0.006) and PCSK9 GG variant (OR=1.30; p=0.047) showed significant increased risk for onset of complication. After logistic regression the two genetic variants remained in the equation: HNF4A CC (OR=3.90; p=0.031) and PCSK9 GG (OR=1.95; p=0.017) with sedentary life (OR=1.71; p<0.0001). Conclusion: According to these results, there are risk factors such as sedentary life and some genetic variants (HNF4A and PCSK9) that are significantly and independently associated with MACE occurrence and allow us to predict vascular complications after CAD diagnosis. If patients have one or more of these conditions, a particularly careful secondary prevention should be ensured.