American Journal of Epidemiology Vol. 130, No. 3: 469-480
Copyright © 1989 by The Johns Hopkins University School of Hygiene and Public Health
research-article |
RISK FACTORS FOR LONG-TERM CORONARY PROGNOSIS AFTER INITIAL MYOCARDIAL INFARCTION: THE FRAMINGHAM STUDY
1Preventive Cardiology Program, Department of Medicine, University of California Irvine, CA.
2Section of Epidemiology and Biostatistics, Boston University School of Public Health Boston, MA.
3Department of Epidemiology and Public Health, Yale University School of Medicine New Haven, CT.
4Framingharn Heart Study Frarningham, MA.
5Section of Preventive Medicine and Epidemiology, Boston University School of Medicine Boston, MA.
Reprint requests to Dr. Nathan D. Wong, Preventive Cardiology Program, Department of Medicine, C240 Med Sci I Building, University of California, Irvine , CA 92717
The role of standard coronary heart disease risk factors in predicting the longterm risk of recurrent coronary events in survivors of myocardial infarction is examined. Of 697 subjects (464 males and 233 females) who experienced an initial myocardial infarction during 30 years of follow-up in the Framingham Study, 459 returned for a baseline examination and were followed for up to 32 years (mean = 9.7 years) for lnddent relnfarction or coronary death. The Cox proportional hazards model was used to evaluate the relation of postinfarction risk factors with reinfarction and coronary death. Age-adjusted analyses showed the risk of reinfarction to be positively associated with blood pressure and serum cholesterol. Risk of coronary death was strongly associated with blood sugar level, systolic blood pressure, serum cholesterol, heart rate, diabetes, and interim reinfarction. In multivariable analyses, systolic pressure, serum cholesterol, and diabetes were predictive of relnfarction; relative weight was inversely associated with reinfarction. Systdic pressure, serum cholesterd, and the prevalence of diabetes persisted as independent predictors of coronary death. When adjustments were made for the effects of these variables, women were at only half the risk of coronary death compared with men. Higher baseline risk factors in women compared with men may obscure an important survival advantage in women. In persons recovered from an initial myocardial infarction, standard risk factors, parbiculady systolic pressure, serum cholesterol, and diabetes, remain important determinants of coronary prognosis over many years and warrant attention In preventing subsequent events.
arteriosclerosis; coronary disease; epidemiologic methods; myocardial infarction
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