Journal List > J Korean Acad Nurs > v.47(6) > 1003286

Ju and Choi: Identifying Latent Classes of Risk Factors for Coronary Artery Disease

Abstract

Purpose

This study aimed to identify latent classes based on major modifiable risk factors for coronary artery disease.

Methods

This was a secondary analysis using data from the electronic medical records of 2,022 patients, who were newly diagnosed with coronary artery disease at a university medical center, from January 2010 to December 2015. Data were analyzed using SPSS version 20.0 for descriptive analysis and Mplus version 7.4 for latent class analysis.

Results

Four latent classes of risk factors for coronary artery disease were identified in the final model: ‘smoking-drinking’, ‘high-risk for dyslipidemia’, ‘high-risk for metabolic syndrome’, and ‘high-risk for diabetes and malnutrition’. The likelihood of these latent classes varied significantly based on socio-demographic characteristics, including age, gender, educational level, and occupation.

Conclusion

The results showed significant heterogeneity in the pattern of risk factors for coronary artery disease. These findings provide helpful data to develop intervention strategies for the effective prevention of coronary artery disease. Specific characteristics depending on the subpopulation should be considered during the development of interventions.

References

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Figure 1.
Class membership probability of latent classes.
jkan-47-817f1.tif
Table 1.
General Characteristics of the Sample (N=2,022)
Variable Category n (%)
Age (yr) <50 220 (10.8)
50~59 532 (26.3)
60~69 545 (27.0)
≥70 725 (35.9)
Gender Men 1,277 (63.2)
Women 745 (36.8)
Educational level Elementary school 468 (23.1)
Middle & high school 944 (46.7)
College or higher 445 (22.0)
Marital status Single 128 (6.3)
Married 1,851 (91.5)
Occupation Office job 236 (11.7)
Housewife 412 (20.4)
General labor job 247 (12.2)
Service job 158 (7.8)
None 587 (29.0)
Other* 208 (10.3)
Family history related Yes 526 (26.0)
to CAD No 1,463 (72.4)

*Other includes soldier, student, & professional technician etc. Family history related to CAD refers to information on family morbidity of particular diseases (hypertension, diabetes mellitus, hyperlipidemia or cardiovascular disease). The sample size varies due to missing data.

CAD=Coronary artery disease.

Table 2.
Descriptive Statistics on Indicator Variables of Coronary Heart Disease Risk Factors of the Sample (N=2,022)
Variable Category n (%)
Hypertension Yes 788 (39.0)
No 1,234 (61.0)
Diabetes Yes 575 (28.4)
No 1,447 (71.6)
Blood glucose Normal (<100) 174 (8.6)
(mg/dL) Impaired fasting glucose (100~125) 1,060 (52.4)
Diabetes (≥126) 788 (39.0)
Dyslipidemia Yes 371 (18.3)
No 1,651 (81.7)
Total cholesterol Desirable (<200) 1,873 (92.6)
(mg/dL) Borderline risk (200~239) 113 (5.6)
High risk (≥240) 36 (1.8)
HDL cholesterol Desirable (≥60) 134 (6.6)
(mg/dL) Borderline risk (M: 41~59, F: 51~59) 608 (30.1)
High risk (M: ≤40, F: ≤50) 1,280 (63.3)
LDL cholesterol Desirable (<100) 1,020 (50.4)
(mg/dL) Borderline risk (100~159) 886 (43.8)
High risk (≥160) 116 (5.8)
Smoking Yes 614 (30.4)
No 1,408 (69.6)
Drinking Yes 686 (33.9)
No 1,336 (66.1)
BMI (kg/m2) Underweight (<18.5) 78 (3.9)
Normal weight (18.5~24.9) 1,064 (52.6)
Overweight/Obesity (≥25) 880 (43.5)
Malnutrition risk Yes 261 (12.9)
No 1,761 (87.1)

M=Male; F=Female; HDL=High density lipoprotein; LDL=Low density lipoprotein; BMI=Body mass index.

Table 3.
Criteria for Model Fit by Different Number of Classes
Number of classes Model Fit Criteria
AIC BIC Adjusted BIC LMR-LRT (p value) BLRT (p value) Entropy
1 28,861.43 28,951.27 28,900.38
2 28,432.70 28,617.88 28,513.04 .012 <.001 0.49
3 28,183.18 28,463.77 28,304.91 .312 <.001 0.57
4 27,961.44 28,337.44 28,124.57 .018 <.001 0.60
5 27,834.42 28,305.81 28,038.94 .064 <.001 0.64

AIC=Akaike information criterion; BIC=Bayesian information criteria; LMR=Lo-mendell-rubin likelihood ratio test; BLRT=Bootstrapped likelihood ratio test.

Table 4.
Differences in General Characteristics and the Incidence of Percutaneous Coronary Intervention (PCI) among Four Latent Classes (N=2,022)
Variables Categories Smoking drinking (n=525) High–risk for dyslipidemia (n=356) High–risk for metabolic syndrome (n=629) High–risk for diabetes & malnutrition (n=512) χ2 (p)
Age (yr) <50 106 (20.2) 48 (13.5) 31 (4.9) 35 (6.8) 249.73 (<.001)
50~59 204 (38.9) 115 (32.3) 115 (18.3) 98 (19.1)
60~69 140 (26.7) 83 (23.3) 186 (29.6) 136 (26.6)
≥70 75 (14.3) 110 (30.9) 297 (47.2) 243 (47.5)
Mean±SD 57.9±10.5 61.0±11.7 68.1±10.9 68.0±11.5
Gender Man 487 (92.8) 196 (55.1) 294 (46.7) 300 (58.6) 285.21 (<.001)
Women 38 (7.2) 160 (44.9) 335 (53.3) 212 (41.4)
Educational Elementary 71 (14.2) 75 (23.7) 188 (32.9) 134 (28.7) 66.06 (<.001)
level Middle & High 272 (54.3) 157 (49.5) 285 (49.8) 230 (49.3)
College or higher 158 (31.5) 85 (26.8) 99 (17.3) 103 (22.1)
Marital status Single 42 (8.2) 30 (8.5) 34 (5.5) 22 (4.4) 9.51 (.023)
Married 470 (91.8) 321 (91.5) 582 (94.5) 478 (95.6)
Occupation Office job 115 (21.9) 50 (14.0) 27 (4.3) 44 (8.6) 307.02 (<.001)
Housewife 21 (4.0) 92 (25.8) 186 (29.6) 113 (22.1)
General labor job 103 (19.6) 37 (10.4) 58 (9.2) 49 (9.6)
Service job 65 (12.4) 26 (7.3) 35 (5.6) 32 (6.2)
None 109 (20.8) 80 (22.5) 215 (34.2) 183 (35.7)
Other* 85 (16.2) 41 (11.5) 42 (6.7) 40 (7.8)
Family history Yes 164 (31.7) 97 (27.6) 177 (28.7) 88 (17.5) 30.20 (<.001)
related to CAD No 353 (68.3) 255 (72.4) 439 (71.3) 416 (82.5)
PCI Yes 291 (55.4) 147 (41.3) 326 (51.8) 243 (47.5) 19.12 (<.001)
No 234 (44.6) 209 (58.7) 303 (48.2) 269 (52.5)

SD=Standard deviation; PCI=Percutaneous coronary intervention; CAD=Coronary artery disease.

*Other includes soldier, student, & professional technician etc; The sample size varies due to missing data.

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