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관상동맥질환 중증도 분류에 따른 성별 위험요인 비교

Comparison of Risk Factors for Men and Women According to Severity Classification in Patients with Coronary Artery Disease

  • 투고 : 2022.04.10
  • 심사 : 2022.08.20
  • 발행 : 2022.08.28

초록

본 연구는 관상동맥질환 자의 관상동맥질환 중증도 분류에 따른 성별 위험요인 차이를 비교하고자 실시하였으며, 일개 종합병원에 처음 입원하여 관상동맥조영술을 실시한 남성 340명, 여성 221명을 대상으로 간호 정보 조사지와 관상동맥질환 중증도 진단 결과 기록을 2차 분석한 후향적 조사연구이다. 대상자가 진단받은 관상동맥질환 중증도 분류에 따라 남녀의 관상동맥질환의 위험요인 차이를 분석한 결과, 남성의 관상동맥질환 중증도 분류에 따른 위험요인은 나이(p=004), 총콜레스테롤(p=.040), 중성지방(p=.049), 당화혈색소(p<.001), 흡연(p<.001), 음주(p=.002), 동반질환(p=.036)에서 통계적으로 유의한 차이가 있었다. 반면 여성의 위험요인은 나이(p=.002)와 동반질환(p=.018)에서만 유의한 차이가 있었다. 남성의 관상동맥질환 중증도 분류에 영향을 주는 유의한 위험요인은 1개 관상동맥에 질환이 있는 군에서는 총콜레스테롤(OR 0.97, 95% CI 0.96-1.00, p=.014), 2개 관상동맥에 질환이 있는 군은 음주(OR 52.47, 95% CI 2.99-91.95, p=.007), 3개 관상동맥에 질환이 있는 군에서 총콜레스테롤(OR 0.98, 95% CI 0.95-0.98, p=.026)이었다. 여성의 관상동맥질환 중증도 분류에 영향을 주는 유의한 위험요인은 3개 관상동맥에 질환이 있는 군에서 동반질환 (OR 0.30, 95% CI 0.11-0.82, p=.020)이었다. 본 연구 결과를 통해 남성 관상동맥질환 자 위험요인 관리에는 금연과 절주, 혈당 조절, 콜레스테롤 관리 및 동반 질환 관리 등의 간호 중재 필요성과 중요성을 알 수 있었다. 본 연구는 관상동맥 중증도 분류에 따라 성별 위험요인 차이를 비교하여 개별적 맞춤형 간호 중재의 근거를 마련했다고 생각한다.

The aim of this retrospective study was to compare risk factors between men and women through secondary data of nursing information and medical records according to the severity classification in patients of 340 men and 221 women with coronary artery disease(CAD) who were admitted for the first time at a general hospital and underwent first coronary artery angiography. Consequently, men presented with risk factors such as age(p=.004), total cholesterol(p=.040), triglycerides(p=.049), HbA1c(p<.001), smoking(p<.001), alcohol consumption(p=.002) and comorbidities(p=.036) that showed statistically significant differences. Among women, age(p=.002) and comorbidities (p=.018) were the only factors that showed significant differences. Significant risk factors influencing the classification of CAD severity in men were total cholesterol (OR 0.97, 95% CI 0.96-1.00, p=.014) in 1VD, alcohol consumption (OR 52.47, 95% CI 2.99-91.95, p=.007)in 2VD, and total cholesterol in the 3VD(OR 0.98, 95% CI 0.95-0.98, p=.026). A significant risk factor affecting the classification of CAD severity in women was comorbidity (OR 0.30, 95% CI 0.11-0.82, p=.020) in the 3VD. This study identified the importance of nursing care for male CAD patients, such as smoking cessation and quitting drinking, blood sugar control, cholesterol, and accompanying disease management, and provided evidence of individually tailored nursing care.

키워드

참고문헌

  1. Statistics Korea. (2021). 2020 statistics of causes of death for Korea. Statistics Korea. http://kostat.go.kr/portal/korea/kor_nw/1/1/index.board?bmode=read&aSeq=403046
  2. R. H. Eckel et al. (2014). 2013 AHA/ACC guideline on lifestyle management to reduce cardiovascular risk: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Journal of the American college of cardiology, 63(25 Part B), 2960-2984. DOI : 10.1161/01.cir.0000437740.48606.d1
  3. D. K. Arnett et al. (2019). 2019 ACC/AHA Guideline on the Primary Prevention of Cardiovascular Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation, 140(11), e596-e646. DOI : 10.1161/CIR.0000000000000678
  4. V. Bittner. (2020). The new 2019 AHA/ACC guideline on the primary prevention of cardiovascular disease. Circulation, 142(25), 2402-2404. DOI : 10.1161/ CIRCULATIONAHA.119.040625
  5. S. Y. KIM. (2018). Factors related to coronary artery disease in korean adults: based on the korean national health and nutrition examination survey 2013~2015. Korean Journal of Rehabilitation Nursing, 33-42. DOI : 10.7587/kjrehn.2018.33
  6. S. Agrawal, J. Van Eyk., K Sobhani, J Wei & CN. Bairey Merz. (2015). Sex, Myocardial Infarction, and the Failure of Risk Scores in Women. Womens Health (Larchmt). 24, 859-861. DOI : 10.1089/jwh.2015.5412
  7. Y. J. Na. (2019). Impact of menopause on the women's health. Journal of the Korean Medical Association, 62(3), 141-144. DOI : 10.5124/jkma.2019.62.3.141
  8. Y. J. KIM & C. Kwak. (2011). Prevalence and associated risk factors for cardiovascular disease: findings from the 2005, 2007 Korea National Health and Nutrition Examination Survey. Korean Journal of Health Promotion, 169-176. https://doi.org/10.15384/kjhp.2018.18.4.169
  9. C. Leuzzi & M. G. Modena. (2010). Coronary artery disease: clinical presentation, diagnosis and prognosis in women. Nutrition, Metabolism and Cardiovascular Diseases, 20(6), 426-435. DOI : 10.1016/j.numecd.2010.02.013
  10. GL. Ghisi, P. Polyzotis, P. Oh, M. Pakosh & SL. Grace. (2013). Physician factors affecting cardiac rehabilitation referral and patient enrollment: a systematic review. Clinical cardiology, 36(6), 323-335. DOI : 10.1002/clc.22126.
  11. L. Xu, S. Ryu & H. Goong. (2015). Gender differences in predictors of health behaviors modification among patients with cardiovascular disease. The Journal of the Korea Contents Association, 15(3), 280-289. DOI : 10.5392/JKCA.2015.15.03.280
  12. M. Walli-Attaei et al. (2020). Variations between women and men in risk factors, treatments, cardiovascular disease incidence, and death in 27 high-income, middle-income, and low-income countries (PURE): a prospective cohort study. The Lancet, 396(10244), 97-109. DOI : 10.1016/S0140-6736(20)30543-2
  13. J. Mei, Y. Tian, X. Chai & X. Fan. (2019). Gender differences in self-care maintenance and its associations among patients with chronic heart failure. International journal of nursing sciences, 6(1), 58-64. DOI : 10.1016/j.ijnss.2018.11.008
  14. D. De Smedt et al. (2016). The gender gap in risk factor control: effects of age and education on the control of cardiovascular risk factors in male and female coronary patients. The EUROASPIRE IV study by the European Society of Cardiology. International journal of cardiology, 209, 284-290. DOI : 10.1016/j.ijcard.2016.02.015
  15. M. S. OH & M. H. JEONG. (2020). Sex differences in cardiovascular disease risk factors among Korean adults. Korean Journal of Medicine, 94(5), 266-275. DOI: 10.3904/kjm.2020.95.4.266
  16. B. Y. Choi. (2021). The Status and Related Factors in Recognizing Myocardial Infarction Symptoms by Population Group: Focusing on Gender Differences. Korean Public Health Research. 47(2), 87-95. DOI : 10.22900/kphr.2021.47.2.008
  17. H. K. Jin & M. J. Kim. (2018). Gender Comparison Factors Influencing Regular Exercise Adherence in Patients with Coronary Artery Disease: Data from the 6th Korea National Health and Nutrition Examination Survey (2013~2015). Journal of Korean Academy of Fundamentals of Nursing, 25(2), 134-145. DOI : 10.7739/jkafn.2018.25.2.134
  18. M. Zhao et al. (2017). Sex differences in risk factor management of coronary heart disease across three regions. Heart, 103(20), 1587-1594. DOI : 10.1136/heartjnl-2017-311429
  19. M. H. Kim. (2019). Risk Factors for Restenosis in Patients with a Percutaneous Coronary Intervention. Doctoral dissertation, Dong-Eui University, Busan.
  20. W. S. Weintraub et al. (2011). ACCF/AHA 2011 key data elements and definitions of a base cardiovascular vocabulary for electronic health records: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Clinical Data Standards. Journal of the American College of Cardiology, 58(2), 202-222. DOI : 10.1161/CIR.0b013e31821ccf71
  21. Y. S. Jang. (2020). A study on the development of guidelines for percutaneous coronary intervention. Wonju: HIRA.
  22. S. H. Kim (2016). New concept of treatment guideline of dyslipidemia. Journal of the Korean Medical Association, 59(5), 349-351. DOI : 10.5124/jkma.2016.59.5.349
  23. S. S. Kweon & Y. H. Lee. (2012). Relationship of average volume of alcohol consumption and binge drinking to arterial stiffness in community-dwelling healthy adults. Journal of agricultural medicine and community health, 37(1), 23-35. DOI : 10.5393/JAMCH.2012.37.1.023
  24. Statistics Korea. (2021). Current smoking rate. StatisticsKorea. https://www.index.go.kr/unify/idx-info.do?idxCd=4237
  25. H. L. Kim et al. (2017). Sex difference in the association between brachial pulse pressure and coronary artery disease: the Korean Women's Chest Pain Registry (KoROSE). The Journal of Clinical Hypertension, 19(1), 38-44. DOI : 10.1111/jch.12862