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Identification of individuals at high risk for myocardial infarction
Insights
This study identified key risk factors for atherosclerotic coronary heart disease (CHD) in middle-aged men. Elevated cholesterol, blood pressure, smoking, and family history significantly increase CHD incidence.
Area of Science:
- Cardiovascular Medicine
- Epidemiology
- Preventive Cardiology
Background:
- Atherosclerotic coronary heart disease (CHD) remains a leading cause of mortality.
- Identifying modifiable and non-modifiable risk factors is crucial for prevention strategies.
Purpose of the Study:
- To assess the incidence of atherosclerotic CHD in a cohort of middle-aged men.
- To identify significant risk factors associated with CHD development.
- To investigate the role of fibrinogen as an independent risk indicator.
Main Methods:
- Prospective cohort study (Prospective Cardiovascular Münster - PROCAM study) involving 4559 male participants aged 40-64 years.
- 6-year follow-up period to record CHD events (nonfatal myocardial infarctions and deaths).
- Multiple logistic function (MLF) analyses to determine associations between risk factors and CHD incidence, adjusting for other variables. Analysis of clotting factors including fibrinogen in a subgroup.
Main Results:
- 186 cases of atherosclerotic CHD were observed during the follow-up.
- Significant risk factors for CHD included age, cholesterol, HDL cholesterol, systolic blood pressure, cigarette smoking, angina pectoris, diabetes mellitus/hyperglycaemia, and family history of myocardial infarction.
- Fibrinogen emerged as an independent additional risk indicator for CHD (P < 0.05).
- Lowest total mortality risk was observed in men with the lowest CHD risk, though relationships between total mortality and single risk factors exhibited 'J'- or 'U'-shaped curves.
Conclusions:
- Established risk factors like age, lipids, blood pressure, smoking, and diabetes are significantly associated with CHD incidence.
- Fibrinogen is identified as an independent predictor of CHD, highlighting its potential role in risk assessment.
- Understanding the complex relationship between risk factors and mortality is essential for comprehensive cardiovascular health management.
Abstract:
The incidence of atherosclerotic coronary heart disease (CHD) was assessed in 4559 male participants of the Prospective Cardiovascular Münster (PROCAM) study, aged 40-64 years, over a 6 year follow-up period. In this time, 186 study participants developed atherosclerotic CHD (134 definite nonfatal myocardial infarctions and 52 definite atherosclerotic CAD deaths including 21 sudden cardiac deaths and 31 fatal myocardial infarctions). In multiple logistic function (MLF) analyses, age, cholesterol, HDL cholesterol, systolic blood pressure, and the binary (yes/no) criteria of cigarette smoking, angina pectoris, diabetes mellitus or hyperglycaemia, and family history of myocardial infarction showed a significant association with the incidence of atherosclerotic CHD after adjustment for the other risk factors. In the subgroup of individuals, in whom clotting factors were measured, fibrinogen was found to be an independent additional risk indicator for CHD by multiple logistic function analysis (P < 0.05). The relationship between a variable and total mortality or some of its components was described by dividing the patient series into quintiles of the studied variable and then calculating the age-standardized death rate for each quintile. Lowest risk of total mortality occurs in men with lowest risk of CHD, though relationships between total mortality and levels of single risk factors are 'J'-shaped or even 'U'-shaped.