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Early and late coronary deaths in the US Railroad study predicted by major coronary risk factors
Alessandro Menotti1, Daan Kromhout, Henry Blackburn
1National Institute for Public Health and Environment, Bilthoven, The Netherlands. menottia@tin.it
Insights
Major coronary risk factors like high cholesterol, blood pressure, and smoking predict coronary heart disease deaths for over 30 years. These risk factors maintain a consistent association with cardiac events in middle-aged men.
Area of Science:
- Cardiology
- Epidemiology
- Preventive Medicine
Background:
- Coronary heart disease (CHD) remains a leading cause of mortality worldwide.
- Understanding the long-term impact of traditional risk factors is crucial for public health strategies.
Purpose of the Study:
- To determine the duration of the association between major coronary risk factors and CHD deaths.
- To analyze the predictive power of single-occasion risk factor measurements over 40 years in middle-aged men.
Main Methods:
- Utilized data from 2376 cardiovascular disease-free men (aged 40-59) from the US Railroad cohort (Seven Countries Study).
- Measured systolic blood pressure, serum total cholesterol, and cigarette smoking in the late 1950s.
- Employed partitioned proportional hazards models across 5-year follow-up blocks to assess risk over 40 years, with 627 CHD deaths recorded.
Main Results:
- A consistent, increasing risk trend for coronary deaths was observed with higher serum cholesterol, systolic blood pressure, and smoking for the initial 30-35 years.
- The predictive power of these risk factors diminished after 30-35 years.
- The association strength remained relatively constant, irrespective of the time elapsed since measurement, with high correlation coefficients (0.96-0.99).
Conclusions:
- Single measurements of major coronary risk factors in middle-aged men show a sustained, monotonic relationship with subsequent CHD deaths for at least 30-35 years.
- These findings underscore the enduring significance of early risk factor assessment in predicting long-term cardiovascular outcomes.
Background:
The purpose of this study was to explore the duration of the association of major coronary risk factors measured on a single occasion with coronary heart disease (CHD) deaths during 40 years in a population sample of middle-aged men.
Design:
Measurement of age, systolic blood pressure, serum total cholesterol, and cigarette smoking was made on a single occasion in 2376 cardiovascular disease free men, aged 40-59, belonging to the US Railroad cohort of the Seven Countries Study enrolled in the late 1950s. During 40 years of follow up 627 men died from typical CHD (sudden death coronary death or definite myocardial infarction).
Methods:
Eight partitioned proportional hazards models were solved, one for each independent 5-year block of follow up, to predict the risk of CHD death. Eight 5-year partitioned hazard scores, derived from the coefficients, were cumulated for each risk factor.
Results:
The resulting curves showed a regularly increasing time trend in risk for coronary deaths as a function of serum cholesterol, systolic blood pressure and cigarette smoking, for the first 30-35 years of follow up followed by a loss of predictive power thereafter. The curves fit straight lines, with large squared correlation coefficients ranging from 0.96 to 0.99. There was a relatively constant strength in the association of risk factors levels with events, which are predicted irrespective of the distance from risk factor measurements.
Conclusions:
Measurement of major coronary risk factors taken on a single occasion in middle-aged men maintained a regular and almost monotonic relationship with the subsequent occurrence of CHD deaths for at least 30-35 years of follow up.
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