Risk factors for coronary artery stenosis in valvular heart disease.
OBJECTIVE
The study was performed to establish the frequency of significant coronary artery stenosis (SCS) in patients with valvular heart disease (VHD), and in particular its correlation with the incidence of angina pectoris and presence of coronary risk factors. The need for coronary arteriography to be performed in all patients with VHD before surgery was also investigated.


METHODS
Retrospective examinations were performed in 1292 patients with VHD (mean age 51 years) who underwent selective coronary angiography before surgery between 1982 and 1990. In each patient the presence of angina pectoris and the following risk factors were noted: cigarette smoking, systemic hypertension, family history of ischemic heart disease, elevated fasting serum lipids, history of diabetes mellitus and overweight.


RESULTS
The incidence of SCS was 13%, was higher in patients with angina, and correlated significantly with coronary risk factors of smoking, hypertension, history of ischemic heart disease, elevated lipids and diabetes, but not with overweight. The incidence of SCS increased progressively with the number of coronary risk factors, from 2% in patients without risk factors, to 6% with one risk factor, and to 21% with two or more risk factors. SCS was not found in patients without coronary risk factors and without angina pectoris below 55 years of age.


CONCLUSIONS
A statistically significant correlation was found between increasing numbers of coronary risk factors and significant coronary artery disease. These results suggest that coronary angiography may not be an obligatory diagnostic step before valve replacement in patients aged < 55 years who have neither risk factors nor angina pectoris.
Orlowska-Baranowska
E
E
National Institute of Cardiology, Warsaw, Poland.
Rawczynska-Englert
I
I
D000328:Adult; D017677:Age Distribution; D000787:Angina Pectoris / Q000453:epidemiology / Q000209:etiology; D016009:Chi-Square Distribution; D015897:Comorbidity; D003327:Coronary Disease / Q000453:epidemiology* / Q000209:etiology; D005260:Female; D006349:Heart Valve Diseases / Q000175:diagnosis / Q000453:epidemiology*; D006801:Humans; D015994:Incidence; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011044:Poland / Q000453:epidemiology; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012307:Risk Factors; D017678:Sex Distribution