Cardiovascular risk factors for stable angina pectoris versus unheralded myocardial infarction
Kristina Dunder1, Lars Lind, Bo Lagerqvist
1Department of Public Health and Caring Sciences/Geriatrics, Uppsala University, Uppsala, Sweden. kristina.dunder@pubcare.uu.se
Insights
This study found that while lipid levels impact both stable and acute coronary heart disease, elevated proinsulin and blood pressure specifically predict unheralded myocardial infarction (MI), suggesting roles in thrombosis or plaque rupture.
Area of Science:
- Cardiology
- Epidemiology
- Biochemistry
Background:
- Ischemic heart disease presents variably, from stable angina to acute myocardial infarction (MI).
- Understanding baseline risk factors differentiating these presentations is crucial for targeted prevention.
- This study investigated risk factors distinguishing stable angina from unheralded MI.
Purpose of the Study:
- To compare baseline risk factors between individuals who developed stable angina pectoris and those who experienced unheralded fatal or nonfatal myocardial infarction (MI).
- To identify independent predictors for stable angina requiring revascularization versus unheralded MI.
Main Methods:
- A nested case-control study utilizing data from a 1970-1973 health survey of 50-year-old men in Uppsala, Sweden.
- Included subjects free of coronary heart disease (CHD) at baseline, followed until 1998.
- Cases comprised 70 patients with angina pectoris without prior MI undergoing revascularization and 372 patients with fatal/nonfatal MI without prior known CHD.
Main Results:
- Low-density lipoprotein and high-density lipoprotein levels were protective against stable angina pectoris.
- Smoking, diastolic blood pressure, serum proinsulin, and serum lipid levels predicted subsequent unheralded MI.
- Higher hazard ratios for diastolic blood pressure and serum proinsulin were observed in the unheralded MI group compared to the stable angina group.
Conclusions:
- Serum lipid levels are significant risk factors for both stable and acute coronary heart disease.
- Proinsulin levels and diastolic blood pressure are independent predictors specifically for unheralded MI.
- These findings suggest proinsulin and blood pressure may play roles in thrombosis and plaque rupture leading to acute events.
Background:
Ischemic heart disease can vary substantially in its clinical presentation. Some patients have acute myocardial infarction (MI) without any previous signs of myocardial ischemia, whereas other patients may have stable angina pectoris for years without periods of acute unstability. This study compared baseline risk factors between subjects in whom stable angina pectoris developed and subjects in whom unheralded fatal or nonfatal MI developed during the follow-up period.
Methods:
In 1970 to 1973, all 50-year-old men in Uppsala, Sweden, were invited to participate in a health survey aimed at identifying risk factors for cardiovascular disease. The present study is a nested case-control study of subjects who were free of coronary heart disease (CHD) at baseline and who then underwent revascularization (percutaneous transluminal coronary angioplasty or coronary artery bypass grafting) because of angina pectoris without preceding MI (n = 70) or in whom fatal or nonfatal MI developed without prior known CHD (n = 372) during the period until 1998.
Results:
In multivariate Cox proportional hazard models, low-density lipoprotein and high-density lipoprotein levels (protective) were significant independent risk factors for stable angina pectoris demanding revascularization, whereas smoking, diastolic blood pressure, serum proinsulin levels, and serum lipid levels were significant independent predictors of subsequent unheralded MI. When comparing hazard ratios (HR), significantly higher HR for diastolic blood pressure (1.40 vs 1.00, for 1 SD increase) and serum proinsulin (1.82 vs1.20, for 1 SD increase) were found in the group in which unheralded MI developed than in the group with stable angina pectoris.
Conclusions:
Serum lipid levels were important risk factors for the development of both stable and acute coronary heart disease. In addition, proinsulin levels and blood pressure were independent predictors of unheralded MI only, which suggests that these factors are involved in thrombosis, plaque rupture, or both.
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