Related Experiment Video
Updated: May 18, 2026
Coronary Progenitor Cells and Soluble Biomarkers in Cardiovascular Prognosis after Coronary Angioplasty
Published on: January 28, 2020
Risk factors for coronary heart disease and survival after myocardial infarction
Sjoerd T Nauta1, Jaap W Deckers, Robert M van der Boon
1Thoraxcentre, Erasmus Medical Centre, Rotterdam, The Netherlands.
Insights
Patients with coronary heart disease risk factors experienced better survival after myocardial infarction. These individuals saw greater mortality reductions over recent decades, highlighting the importance of managing risk factors.
Area of Science:
- Cardiology
- Public Health
- Epidemiology
Background:
- Coronary heart disease (CHD) risk factors are often linked to adverse health outcomes.
- A paradoxical association has been observed between CHD risk factors and improved in-hospital survival post-myocardial infarction (MI).
Purpose of the Study:
- To confirm the paradox of improved survival in MI patients with CHD risk factors.
- To determine if this survival benefit extends to long-term outcomes.
- To investigate temporal trends in mortality rates over time.
Main Methods:
- Analysis of 14,434 patients admitted with MI between 1985 and 2008.
- Examined the association between four modifiable CHD risk factors (hypertension, dyslipidaemia, diabetes, smoking) and mortality.
- Utilized survival analysis to assess 30-day and 10-year mortality rates.
Main Results:
- Two-thirds of MI patients possessed at least one CHD risk factor.
- The presence of at least one risk factor was linked to a favorable 30-day mortality rate (5% vs. 7%).
- While the 10-year mortality hazard ratio (HR) initially favored those without risk factors (1.2 in 1985-1990), it became similar or favorable in later periods (0.89 in 2000-2008).
- Significant improvements in 10-year survival were observed over time, particularly for patients with CHD risk factors.
Conclusions:
- The presence of modifiable CHD risk factors is associated with improved outcomes following MI.
- Patients with CHD risk factors have experienced more substantial reductions in mortality over recent decades.
- Managing CHD risk factors remains crucial for improving long-term prognosis after myocardial infarction.
Objectives:
Several risk factors for coronary heart disease (CHD) have been associated with improved in-hospital survival after myocardial infarction (MI). We aimed to confirm this paradox and assess whether it extends to long-term outcome. In addition, we investigated temporal mortality trends.
Methods:
We examined the relation between the presence of four modifiable risk factors for CHD (hypertension, dyslipidaemia, diabetes mellitus and smoking) and mortality in 14,434 consecutive patients admitted with MI to a coronary care unit from 1985 to 2008.
Results:
Two-thirds of MI patients (n = 10,003) had at least one risk factor for CHD on hospital admission. The presence of at least one compared to no CHD risk factors was associated with a favourable 30-day mortality rate (5% vs. 7%, adjusted odds ratio 0.72, 95% confidence interval (CI): 0.62-0.83). There was significant interaction between the presence of CHD risk factors and decade of hospitalization (p = 0.001). The adjusted 10-year mortality hazard ratio (HR) of at least one CHD risk factor compared to none, was 1.2 (95% CI: 1.0--1.4), 0.89 (0.65--1.2) and 0.89 (0.79--0.99) in 1985--1990, 1990--2000 and 2000--2008, respectively. Survival improved over time. Adjusted 10-year mortality fell (adjusted HR [2000--2008 vs. 1985--1990] 0.59 [95% CI: 0.52--0.66] in patients with, and 0.76 [95% CI: 0.65-0.89] in those without CHD risk factors).
Conclusions:
The presence of at least one modifiable CHD risk factor was associated with improved outcome after MI. Patients with CHD risk factors benefited from more substantial mortality reductions during the past few decades.
Related Concept Videos
01:30Coronary Artery Disease I: Introduction
01:27Heart Failure I: Introduction
01:26Coronary Artery Disease IV: Preventive Measures
01:26Coronary Artery Disease II: Pathophysiology
01:27Coronary Artery Disease V: Interprofessional Care
01:17Ischemic Heart Disease: Overview
Atherosclerosis, the primary malefactor, orchestrates this dangerous condition. It manifests as the accumulation of fatty deposits, akin to insidious plaques, within arterial walls. As time elapses, these plaques metamorphose, hardening and narrowing...