CARDIOVASCULAR MEDICINE

Coronary risk factors predicting early and late coronary deaths

A Menotti¹, M Lanti²

¹ Division of Epidemiology, University of Minnesota, Minneapolis, Minnesota, USA
² Association for Cardiac Research-Associazione per la Ricerca Cardiologica Rome, Italy

Correspondence to:
Correspondence to:
Dr M Lanti, Associazione per la Ricerca Cardiologica, Via Adda 87, Rome, Italy 00198;
mplanti{at}tin.it

Objective: To study the time related association of a single measurement of coronary risk factors with coronary heart disease (CHD) deaths occurring during a very long follow up period in a population sample of middle aged men.

Design, setting, and methods: Age, systolic blood pressure, serum total cholesterol, physical activity at work, body mass index, and cigarette smoking were measured once in 1622 CHD-free men aged 40–59 belonging to the Italian rural cohorts of the seven countries study. During 35 years of follow up 214 men died from CHD (sudden death and definite myocardial infarction). Seven partitioned proportional hazards models were solved, one for each independent five year block of follow up, to predict the risk of CHD death.

Results: The seven, five year partitioned hazard functions were cumulated and smoothed for each risk factor. The resulting curves showed a regularly increasing time trend in risk for coronary deaths as a function of age, serum cholesterol, systolic blood pressure, and cigarette smoking and a regularly decreasing risk for physical activity. The curves fit straight lines, with large squared correlation coefficients ranging from 0.92–0.97. This suggests a relatively constant strength in the association of risk factor levels with events, which are predicted whatever the length of time after risk factors were measured. These findings were not altered by adding to the models risk factor changes preceding the quinquennium of death.

Conclusion: A single measurement of some coronary risk factors in middle aged men maintains a regular and almost monotonic relation with the occurrence of CHD deaths during 35 years of follow up.

Keywords: coronary heart disease; prediction; long term follow up; coronary risk factors

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