[Aortic stenosis and coronary disease. Analysis of risk factors].
OBJECTIVE
To analyze clinical laboratorial aspects of the presence of coronary disease in patients with aortic stenosis and evaluate the influence of risk factors in the development of obstructive coronary disease.


METHODS
We studied 65 patients who had severe aortic stenosis with an indication for surgery, ages 51 to 85 years, 40 of them women. The coronary angiography assessment resulted in two groups: 26 (40%) with obstructive coronary disease and 39 (60%) with no coronary artery lesion. Personal antecedents for coronary disease (smoking, dyslipidemia, diabetes mellitus, arterial hypertension, family antecedents, sedentarism, and alcoholism) were analyzed. Additionally, the following assessments were made: electrocardiogram, echocardiogram with Doppler, and laboratory tests (blood glucose, total cholesterol and fractions, triglycerides, Apo-A1 and B, fibrinogen, lipoprotein (a) and fraction of triglycerides and cholesterol removal in both groups.


RESULTS
In the age analysis, the group with obstructive coronary disease belonged to an older age range with statistical significance (p<0.0001). Signs of ischemia of the anterior wall identified on the electrocardiogram showed a significant relationship with the obstruction of an anterior interventricular artery (p<0.002). The univariate analysis showed a significant difference between the groups regarding averages of the aortic (p= 0.041), HDL (p=0.042), and fibrinogen (p=0.047) gradients. The group with coronary disease presented an average gradient and HDL level lower than the group without obstructive coronary disease. For the fibrinogen variable, the average in the group with no coronary disease was lower compared to that of the coronariopathy group. The multivariate logistic regression analysis showed fibrinogen levels as an independent variable for coronary disease (p<0.039).


CONCLUSIONS
Fibrinogen was an independent risk factor for the association between obstructive coronary disease and aortic stenosis.
Rangel
Claudio Magalhães
CM
Instituto do Coração, Hospital das Clínicas, FMUSP, São Paulo, SP, Brazil. cmsrangel@terra.com.br
Grinberg
Max
M
Maranhão
Raul Cavalcante
RC
Ventura
Laura Inês
LI
D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D001024:Aortic Valve Stenosis / Q000150:complications* / Q000601:surgery; D003327:Coronary Disease / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*; D015150:Echocardiography, Doppler; D004562:Electrocardiography; D005260:Female; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D012680:Sensitivity and Specificity; D012737:Sex Factors