Annals of Occupational and Environmental Medicine

The Korean Society of Occupational & Environmental Medicine (대한직업환경의학회)
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Comparison of Cardiovascular Disease Risk Assessment Tools by Using Coronary CT Angiography

관상동맥 CT 혈관조영술을 이용한 심혈관질환 위험도 평가도구 비교

  • Kim, Myeong-Bo (Department of Occupational and Environmental Medicine, Chonnam National University College of Medicine) ;
  • Park, Won-Ju (Department of Occupational and Environmental Medicine, Chonnam National University College of Medicine) ;
  • Jang, Keun-Ho (Department of Occupational and Environmental Medicine, Chonnam National University College of Medicine) ;
  • Lee, Dae-Kwang (Department of Occupational and Environmental Medicine, Chonnam National University College of Medicine) ;
  • Chae, Hong-Jae (Department of Occupational and Environmental Medicine, Chonnam National University College of Medicine) ;
  • Moon, Jai-Dong (Department of Occupational and Environmental Medicine, Chonnam National University College of Medicine)
  • 김명보 (전남대학교 의과대학 산업의학교실) ;
  • 박원주 (전남대학교 의과대학 산업의학교실) ;
  • 장근호 (전남대학교 의과대학 산업의학교실) ;
  • 이대광 (전남대학교 의과대학 산업의학교실) ;
  • 채홍재 (전남대학교 의과대학 산업의학교실) ;
  • 문재동 (전남대학교 의과대학 산업의학교실)
  • Received : 2009.12.23
  • Accepted : 2010.05.03
  • Published : 2010.06.30
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Abstract

Objective: The prevalence and mortality rate of cardiovascular disease (CVD) have increased among Koreans over the past 20 years. To manage and control this disease, various CVD risk assessment tools such as KOSHA (Korean Occupational Safety and Health Agent) CVD risk assessment, the presence of metabolic syndrome and the Framingham risk score (FRS) have been developed and applied to employees at the workplace. This study was designed to compare the validity of the CVD risk assessment tools mentioned above with the findings of coronary CT angiography (CCTA). Methods: The subjects of this study who were 490 male-workers aged between 31 and 70, and these subjects were selected among those who had visited a University Hospital for a general health examination and who underwent CCTA from January 2007 to June 2009. Chi-square tests and logistic regression analysis were used to compare and analyze the associations between the CVD risk assessment tools and the coronary artery changes such as calcification and stenosis. Results: Metabolic syndrome (OR=1.90, 95% CI 1.23-2.95) and the Framingham risk score (OR=2.71, 95% CI 1.83-4.01) were the significant and meaningful predictors of coronary artery calcification. On the analysis of the association with coronary artery stenosis, only the Framingham risk score (OR=2.21, 95% CI 1.46-3.36) turned out to be a significant and meaningful predictor. Conclusion: The results suggest that the Framingham risk score is a relatively valid CVD risk assessment tool. Henceforth, to effectively manage cardiovascular diseases in the workplace, advanced tools and indicators for management should be considered and provided based on meaningful study results.

목적: 최근 심혈관질환의 유병율 및 사망률이 높아지면서 이에 대한 관리의 중요성이 증대되어 여러 가지 심혈관질환 위험도 평가 도구가 개발되었으며 이를 사업장 내에서 활용하려는 시도들이 이루어지고 있다. 하지만 이러한 심혈관질환 위험도 평가도구에 대해 비교한 연구는 현재까지 없는 실정이어서, 최근 활용도가 높아지고 있는 관상동맥 CT 혈관조영술 결과와 심혈관질환 위험도 평가 도구로 널리 사용이 되고 있는 심혈관질환 발병위험도 평가(KOSHA code H-46-2008), 대사증후군, Framingham risk score를 비교하고자 하였다. 방법: 2007년 1월부터 2009년 6월까지 건강진단을 목적으로 일개 대학병원에 내원하여 관상동맥 CT 혈관조영술을 포함한 건강검진을 시행한 31~70세 사이의 성인 남성 근로자 490명을 연구대상자로 선정하였다. 문진, 신체계측, 혈액검사를 통하여 여러 가지 심혈관질환 발병 위험인자에 대해 파악하였고, 이를 토대로 각각의 심혈관질환 위험 수준을 평가하여 관상동맥 CT 혈관조영술을 통해 확인한 관상동맥 석회화 및 협착과 비교 분석하였다. 또한 로지스틱 회귀분석을 통해 심혈관질환 위험도 평가도구들이 관상동맥 석회화 및 협착과 관계가 있는 유의한 예측 인자 인지를 알아보았다. 결과: 모든 심혈관질환 위험도 평가도구에서 위험수준이 증가함에 따라 관상동맥 석회화가 증가하는 경향을 보였으나, 대사증후군(OR=1.90, 95% CI 1.23~2.95)과 Framingham risk score (OR=2.71, 95% CI 1.83~4.01)만이 관상동맥 석회화의 유의한 예측지표이었고, 관상동맥 협착에서는 Framingham risk score만이 유의한 예측지표(OR=2.21, 95% CI 1.46~3.36) 이었다. 또한 설명력에 있어서도 Framingham risk score에서 가장 높았다. 결론: Framingham risk score가 심혈관질환의 발병을 예측하는 위험도 평가로서 가장 타당한 도구였으며, 대사증후군은 제한적인 의미를 지니고 있었다. 특히, 심혈관질환 발병위험도 평가(KOSHA)는 단일 시점의 혈압만을 이용하고 고혈압 기왕력자에 대한 고려를 하지 못하므로 심혈관질환 위험도 평가도구로 효과적이지 못함을 확인 할 수 있었다. 향후 다양한 위험예측지표들의 타당성과 활용가능성에 대한 지속적인 평가와 이를 근거로 한 개선된 관리기준이 시의 적절하게 제시되어야 할 것이며, 이를 통한 사업장 내에서 심혈관질환의 효율적인 관리가 이루어져야 할 것으로 사료된다.

Keywords

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