부산대학교 도서관

Cardiovascular disease (CVD) represents a global health problem with high morbidity and mortality. Atherosclerosis, the cause of CVD, is a systemic inflammatory disease that is influenced by traditional cardiovascular risk factors: age, gender, high blood pressure (HBP), dyslipidaemia (DLP), smoking, diabetes mellitus (DM), obesity and chronic kidney disease ( CKD), as Atrial fibrillation (AF) and prior vascular disease (PVD) are also contributing factors to CVD. Changes in the atherosclerotic plaque can lead to an acute vascular event in different territories: acute coronary syndrome (ACS), cerebrovascular (stroke) or peripheral arterial critical limb disease (PAD). The development of a clinical atherosclerotic event in one arterial vascular territory is not fully understood, but patients tend to repeat events in the same territory. This thesis shows that an association between cardiovascular risk factors and the probability of developing an atherosclerotic event in a particular territory can be made. The study group consists on 2993 patients that were admitted consecutively in the emergency room due to an acute vascular event, ACS, CVA or PAD during a 3 years period. Demographic data, CVR factors, previous events (PVD), previous treatments, in hospital readmission and mortality during the study period were collected from the medical record in a data base. The study also included the evaluation lipid and glycaemic control (HvA1c) and renal function by blood samples analysis. The study compared the collected data for the three events. The analysis of data shows that the population included in this study had a high prevalence of classical CV risk factors, there were less proportion of women and first events appeared in older ages than other populations described in the literature. The characteristics of the studied group were: 74.2 years old [62.9; 81.4], 70.7% men, 75.6% HBP, 59% DLP 20.2% DLP-atherogenic, 18.4% FA, 23% MRC,> 35.7% PVD DM 40%, preDM in 30.3% and 7% of patients have been diagnosed of of new onset hypertension. HbA1C helped detecting 7.2% of new onset DM, showing that HbA1c study should be included for all patients diagnosed for an accute vascular event . The study shows that the secondary prevention for the vascular events included needs to be improved. In particular, we detected a lesser use of antihypertensive drugs in the patients admitted due to a first stroke even if they represented higher proportion of HBP. In our series there was 6.6% inhospital mortality. Mortality rate tended to be higher in patients admitted by PAD than by SCA. Predisposing readmission risk factors were: presence of PVD, CKD, DM and tobacco. However in the> 75 years these factors were: PVD and DM. Factors that have a positive influence on presenting ACS instead of the other two vascular accidents were: DLP, obesity, tobacco exposure (smokers and ex-smokers) and CKD. In the cerebrovascular territory predisposing factors are: the elderly, HBP and AF. Older age and DM are factors that influence in presenting PAD instead of an ACV or ACS. In DM patients the influence of other risk factors is attenuated when having the first acute vascular event. HBP and AF mantain their influence in suffering a first stroke in population with DM.