ABC | Volume 110, Nº3, March 2018

Original Article Xu et al Association of severity of coronary lesions with BMD Arq Bras Cardiol. 2018; 110(3):211-216 Methods Study population A total of 122 female patients who were admitted to the cardiology clinic with chest pain between January 2014 and August 2016 were included in the study. Inclusion criteria were postmenopausal women aged ≥ 50 years, who were diagnosed with acute coronary syndrome or chronic CAD. This diagnosis was made by history of angina pectoris or myocardial infarction, electrocardiographic findings, cardiac enzymes, and coronary angiography results. These patients underwent a bone densitometry on a routine basis within the previous 12 months, and were not taking any medication with known effect on bone turnover. Exclusion criteria were patients with normal coronary angiography; patients who had moderate-to-severe heart valve disease and decompensated heart failure; patients with severe kidney or liver failure, malignancy, hematological diseases, or autoimmune disorder. Clinical features and laboratory examination The weight and height were measured at each of eligible patient. Body mass index (BMI) was calculated as body weight/height 2 (kg/m 2 ). Information concerning the history of diseases (diabetes, hypertension, and hyperlipidemia) was collected using a standard questionnaire. Hypertension was defined as history of hypertension and/or an average systolic blood pressure (SBP) ≥ 140 mmHg and/or an average diastolic blood pressure (DBP) ≥ 90 mmHg on two separate occasions. Diabetes was defined as history or presence of diabetes and/or a fasting plasma glucose level > 126 mg/dL on 2 separate occasions, or a random glucose value of > 200 mg/dL on one or more occasion. Hypercholesterolemia was defined as a total serum cholesterol level of > 240 mg/dL; high triglyceride (TG) and high LDL‑cholesterol (LDL-c) were defined as total serum TG > 200 mg/dL and LDL-C > 160 mg/dL, respectively. BMD measurement Participants had undergone a BMD test of the left femoral neck bone by dual-energy X-ray absorptiometry using a QDR 4500A fan beam bone densitometer (Bedford, MA, USA) according to the manufacturer’s instructions within the previous 12 months. BMD results were reported as T-scores, which were also categorized into three groups according to the World Health Organization (WHO) criteria for diagnosing osteoporosis: normal BMD (T-score≥-1 SD); osteopenia (T < -1 SD and > -2.5 SD); and osteoporosis (T-score ≤ -2.5 SD). 11 Gensini risk scoring Coronary angiography was performed in all subjects. Gensini score: angiographic stenosis of a culprit artery in the range of 0% to 25% was scored as 1 point, stenosis in the range of 25% to 50% was scored as 2 points, 50% to 75% was scored as 4 points, 75% to 90% was scored as 8 points, 90% to 99% was scored as 16 points, and total occlusion was scored as 32 points. A multiplier was assigned to each vascular segment based on the functional significance of the myocardial area supplied by that segment: 5 for the left main coronary artery, 2.5 for the proximal segment of the left anterior descending (LAD) coronary artery and the proximal segment of the circumflex artery, 1.5 for the mid-segment of the LAD, 1.0 for the right coronary artery, the distal segment of the LAD, the mid-distal region of the circumflex artery, the posterolateral artery, and the obtuse marginal artery, and 0.5 for other segments. 12 Angiographic evaluations were reviewed by the consensus of two observers with more than two years of experience. Based on the Gensini score, patients were divided into two groups – 37 patients in the group of mild coronary lesions (Gensini score < 25 points) and 85 patients in the group of severe coronary lesions (Gensini score ≥ 25 points); this grouping was compatible with the literature. 13 Statistical analyses Analyses were carried out using SPSS version 17.0 (SPSS Inc., Chicago, IL). Continuous variables with a Gaussian distribution are presented as mean ± standard deviation (SD), and those with a non-Gaussian distribution are presented as median values with corresponding 25th and 75th percentiles. The normal distribution of different parameters was verified with the Kolmogorov‑Smirnov test. Differences between the groups were evaluated using unpaired t-test or the Mann‑Whitney U-test. Categorical variables were compared with the chi-square test or Fisher’s exact test (Fisher’s exact test was used for frequencies of osteoporosis in Table 2). The association between BMD and risk for severe coronary lesions was evaluated by multiple logistic regression analysis. Multiple linear regression analysis was performed to assess whether BMD was the independent explanatory factor for the severity of coronary lesions (assessed by the Gensini score) in postmenopausal women. Statistical significance was set at p < 0.05 (2-tailed). Results A total of 122 postmenopausal women (mean age 64.31 ± 4.71) were included in the present study, 69.7% of whom exhibited severe coronary lesions. Clinical characteristics of all participants at baseline are summarized in Table 1. In all, 19.6% of the patients were found to have osteoporosis in the femoral neck and 41.8% osteopenia; 39.3% of the women suffered from high blood pressure, 38.5% have diabetes, and 31.1% have hyperlipidemia. Table 2 shows the comparison between the groups with mild coronary lesions and severe coronary lesions in terms of some clinical parameters. Patients with severe coronary lesions patients were older, and had higher prevalence of diabetes and osteoporosis/osteopenia compared with those with mild coronary lesions (p < 0.05). There were no differences between the groups with respect to BMI, proportions of patients with hypertension and hyperlipidemia. Univariate logistic regression analysis showed that osteoporosis/osteopenia was a risk factor for severe coronary lesions (OR = 2.51, 95% CI, 1.153–5.657, p = 0.003). 212