In this study, the prevalence was 302/6542=0.046, representing a 4.6% CAE prevalence among all patients undergoing angiography. Eighty-five patients were excluded. There were 21 patients with congestive heart failure, 26 patients with abnormal hepatic or renal function, and 38 patients who met other exclusion criteria.
The baseline characteristics of the risk factors associated with CAE, including sex (male), hypertension, diabetes, hyperlipidemia, and smoking history, were similar between the total CAE group and the NC group. Particularly, WBC was not different between the groups. In addition, subclasses of leukocytes, such as neutrophils and lymphocytes, were not significantly different between the NC group and total CAE group.
Laboratory findings such as TC, LDL-C, Hs-CRP, WBC, and IL-6 were elevated in the total CAE group compared to those in the NC group (p<0.05). The levels of TC, LDL-C, Hs-CRP, and IL-6 were higher in the CAE-A group than in the CAE-B, CAE-C, and NC groups; furthermore, the levels of TC, LDL-C, Hs-CRP, and IL-6 in the CAE-B group were higher than those in the CAE-C or NC group. Under similar circumstances, the levels of TC, LDL-C, Hs-CRP, and IL-6 in the CAE-C group were higher than those in the NC group. There were significant differences in Hs-CRP between the CAE-A and CAE-C groups (P=0.048) and significant differences in IL-6 between the CAE-A and CAE-C groups (P=0.025). There were no significant differences in sex, hypertension, diabetes, waist circumference, smoking index, TGs, glycosylated hemoglobin, red blood cell distribution width (RBW), or mean platelet volume among the three different age groups of CAE patients (p>0.05; Table 1).
Logistic regression analysis was performed to identify the independent risk factors associated with CAE. In the stepwise analysis, covariant factors included hypertension, diabetes mellitus, Hs-CRP, LDL-C, smoking, triglycerides, WBC, and IL-6. Multivariate analysis showed that increased levels of Hs-CRP and IL-6 were independent predictors of CAE (p<0.05; Table 2). Multivariate analysis showed that increased levels of Hs-CRP (OR, 1.782; CI, 1.124-2.014; p = 0.021) and IL-6 (OR, 1.584; CI, 1.112-1.986; p = 0.030) were independent predictors of CAE (Table 2). The baseline drug treatments of patients with a confirmed diagnosis of CAE at study inclusion are shown in Table 3. Each CAE patient was subjected to rosuvastatin treatment, with or without other drugs such as angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers (ACEIs/ARBs), beta-receptor blockers, calcium-channel blockers, diuretics, aspirin, and clopidogrel. The patients in the NC group received rosuvastatin treatment. There were no significant differences in the selection of therapeutic medications among the three CAE groups and the NC group, except for differences in rosuvastatin (p>0.05).Regarding compliance issues, the three authors, who have some prestige, were dedicated to ensuring patient compliance, regular health education, and regular outpatient follow-up visits and reminding patients to take medication by telephone, WeChat and other means; for various reasons, such as financial constraints, some patients could not access drugs.
Table 2. Multivariate analysis of variables associated with CAE
|
OR
|
95% CI
|
p-value
|
Hypertension
|
1.364
|
0.932–1.648
|
0.248
|
Diabetes mellitus
|
1.407
|
0.802–2.053
|
0.198
|
Waist circumference
|
1.448
|
0.967–1.938
|
0.124
|
LDL-C
|
1.492
|
0.986–2.091
|
0.099
|
Smoking
|
1.119
|
0.932–1.422
|
0.176
|
TGs
|
1.238
|
0.836–1.865
|
0.236
|
WBC
|
1.690
|
0.990–1.785
|
0.061
|
Hs-CRP
|
1.782
|
1.124–2.014
|
0.021*
|
Interleukin-6
|
1.584
|
1.112-1.986
|
0.030*
|
CAE: coronary artery ectasia; Hs-CRP: high-sensitivity C-reactive protein; LDL-C: low-density lipoprotein cholesterol; TGs: triglycerides; WBC: white blood cells. *: p<0.05 vs NC group OR, odds ratio and CI, confidence interval
Table 3. Baseline medication selection of CAE patients after confirmed diagnosis
Treatments
|
Group NC (n=73)
|
CAE-A (n=60)
(age≤50 years)
|
CAE-B (n=83) (50 years<age≤70 years)
|
CAE-C (n=74) (age>70 years)
|
Total CAE (A+B+C, n=217)
|
p-value
|
ACEI/ARB
|
18
|
16
|
27
|
28
|
71
|
0.895
|
β-receptor blocker
|
21
|
25
|
36
|
28
|
89
|
0.424
|
Rosuvastatin
|
73
|
60
|
83
|
74
|
217
|
NA
|
Calcium-channel blocker
|
16
|
18
|
15
|
17
|
50
|
0.310
|
Diuretics
|
14
|
15
|
13
|
16
|
44
|
0.769
|
Aspirin
|
35
|
42
|
56
|
50
|
148
|
0.424
|
p-value: total CAE vs NC. CAE, coronary artery ectasia. ACE, angiotensin-converting enzyme.
After the 6-month treatment with rosuvastatin, serum levels of Hs-CRP and IL-6 were differentially reduced in the three CAE age groups (Table 4), supporting the efficacy of rosuvastatin as an anti-inflammatory agent. Among the three CAE age groups, the CAE-A (age ≤50 years) group showed the greatest effect of rosuvastatin treatment, as evidenced by the most significant reduction in serum levels of Hs-CRP (delta value was 15.1±3.33, P=0.0001) and IL-6 (delta value was 5.9±1.6, P=0.021). The CAE-A group showed the greatest reduction in serum levels of Hs-CRP and IL-6, followed by the CAE-B group (delta value of Hs-CRP was 9.4±2.86, delta value of IL-6 was 3.0±1.5). The results of follow-up found that younger patients had a greater reduction in the serum levels of Hs-CRP and IL-6, suggesting that rosuvastatin had a greater anti-inflammatory effect in younger patients (Table 4). Moreover, comparisons between CAE groups of different ages revealed that the highest serum levels of Hs-CRP and IL-6 were found in younger CAE patients (CAE-A), suggesting that cardiovascular inflammation related to CAE may occur at a comparatively younger age (Table 4).
Table 4. Comparison of serum Hs-CRP and IL-6 levels in CAE patients treated with rosuvastatin
Groups
|
CAE-A (n=60) (age ≤50)
|
CAE-B (n=83) (50<age≤70)
|
CAE-C (n=74) (age >70)
|
|
Pretreatment
|
Posttreatment
|
Delta
|
p-value
|
Pretreatment
|
Posttreatment
|
Delta
|
p-value
|
Pretreatment
|
Posttreatment
|
Delta
|
p-value
|
Hs-CRP (mg/L)
|
32.3 ± 5.51
|
17.5 ± 2.38 *
|
15.1 ±3.3
|
0.0001
|
26.1 ± 4.23
|
18.8 ± 2.74 *
|
9.4 ± 2.86
|
0.023
|
22.5 ± 4.82
|
19.8 ± 2.98
|
4.5 ± 3.12
|
0.310
|
IL-6 (pg/dL)
|
12.3 ± 1.5
|
6.4 ± 1.7*
|
5.9 ±1.6
|
0.021
|
10.9 ± 1.3
|
7.5 ± 2.0*
|
3.0 ± 1.5
|
0.043
|
8.9 ± 1.1
|
7.6 ± 2.3
|
1.9 ± 1.5
|
0.519
|
CAE: coronary artery ectasia. Hs-CRP: high-sensitivity C-reactive protein. IL-6: interleukin-6. Pretreatment: values measured at study inclusion. Posttreatment: values measured after 6 months of treatment with rosuvastatin. *: p<0.05 vs corresponding pretreatment group.