The relationship of reported parental history to the incidence of coronary heart disease in the Western Collaborative Group Study.

The relationship of a reported parental history of coronary heart disease (CHD) to the incidence of CHD was determined in this prospective study of CHD in an intake population of 39-59-year old men. Reported parental history of CHD was found to be associated with level of schooling, the type A behavior pattern, serum cholesterol and beta/alpha lipoprotein ratio. Men with reported parental history had an increased incidence of angina pectoris in both age defined by symptomatic myocardial infarction and sudden coronary death. Adjustment then was made simultaneously for the confounding effects of the risk factors found to be associated with the prevalence of parental history of CHD. After such adjustment a reported parental history of CHD was still found to have a significant association (p = 0.01) with the combined incidence of symptomatic myocardial infarction and angina pectoris in subjects under 50 years of age.     

A prospective study of age at menarche, parity, age at first birth, and coronary heart disease in women

Reproductive events in women are associated with alterations in blood lipids and blood pressure and may therefore influence determinants of coronary heart disease. To investigate the risk of coronary heart disease in relation to age at menarche, parity, and age at first birth, the authors evaluated prospectively the experience of 119,963 US women aged 30-55 years who were free from coronary heart disease in 1976 and were followed through 1982. During 700,809 person-years of observation, 308 incident cases of nonfatal myocardial infarction or fatal coronary heart disease occurred. Younger age at menarche was weakly associated with coronary heart disease (age-adjusted rate ratio of 1.3 for menarche before age 11 years compared with menarche at age 13 years; chi, Mantel extension test for trend = -1.1, p = 0.2). Nulliparous women experienced only a slightly higher rate of coronary heart disease than parous women (rate ratio = 1.2, 95 per cent confidence interval 0.8-1.8). Among parous women, there was no alteration in risk with increasing number of births. Likewise, there was no significant association between age at first birth and coronary heart disease (chi, Mantel extension test for trend = -0.4, p = 0.4). Established risk factors for coronary heart disease nevertheless showed expected relations. These findings show no important association between reproductive experiences and risk of coronary heart disease.     

A prospective study of high blood pressure and cardiovascular disease in women

The relation of self-reported high blood pressure to the subsequent development of coronary heart disease and stroke was examined in a cohort of 119,963 women, aged 30-55 years, who were initially free from cardiovascular disease. Participants in the Nurses' Health Study reported high blood pressure and other cardiovascular risk factors on baseline questionnaires mailed in 1976. During six years of follow-up, there were 308 incident cases of coronary heart disease (66 fatal and 242 nonfatal myocardial infarctions) and 175 strokes (50 fatal and 125 nonfatal). Fatal as well as nonfatal coronary heart disease and stroke were all significantly more frequent among the women who had reported high blood pressure. After adjusting simultaneously for age and other risk factors, the relative risks were 3.5 (95% confidence interval (Cl) 2.8-4.5) for total coronary heart disease and 2.6 (95% Cl 1.8-3.5) for total stroke. This association was evident at all levels of relative weight. The results emphasize the importance of high blood pressure as an independent predictor of coronary heart disease and stroke in middle-aged women and suggest that the increased risk occurs in both lean and obese women.     

High prevalence of angina pectoris in Mexican-American men. A population with reduced risk of myocardial infarction.

Mexican-American men experience lower rates of cardiovascular mortality and have a lower prevalence of nonfatal myocardial infarction than do non-Hispanic white men. To see if this ethnic difference exists for other cardiovascular end points, we compared the prevalence of angina pectoris, as assessed by the Rose Angina Questionnaire, between Mexican Americans (n = 3272) and non-Hispanic whites (n = 1848) examined in the San Antonio Heart Study, a population-based survey of cardiovascular disease and diabetes conducted in San Antonio, Texas, between 1979 and 1988. Contrary to our expectations, angina prevalence was approximately twice as high in Mexican Americans as in non-Hispanic whites, with age-adjusted odds ratios of 2.01 (95% confidence interval (CI), 1.13 to 3.58; P = .02) in men and 1.84 (95% CI, 1.26 to 2.70; P = .001) in women. After controlling for age, body mass index, diabetes status, cigarette smoking, and educational level by logistic regression analysis, angina prevalence remained statistically associated with Mexican American ethnicity in men, but not women. There was little ethnic difference in the proportion of Mexican-American and non-Hispanic white subjects who reported nonspecific chest pain (chest pain not meeting the Rose criteria), suggesting that the ethnic difference in angina prevalence was not an artifact of reporting bias. This was further supported by the fact that the conventional cardiovascular risk factors were more strongly associated with angina prevalence in Mexican Americans than in non-Hispanic whites. These data suggest that Mexican-American men experience high rates of angina despite low rates of myocardial infarction. Future studies should investigate ethnic factors that may have differential effects on the various manifestations of coronary heart disease.     

Vasectomy and subsequent cardiovascular disease in US physicians.

Due to previous animal research suggesting accelerated atherosclerosis following vasectomy, we examined whether vasectomy increases the risk of subsequent cardiovascular disease (CVD), including myocardial infarction (MI), angina pectoris, coronary revascularization, and stroke, in the US Physicians' Health Study. Of 22,071 US male physicians participating in the study, aged 40 to 84 years at entry and free from cardiovascular disease and cancer, 21,028 reported on the 60-month questionnaire whether they had undergone vasectomy prior to randomization. Of the 4546 physicians with vasectomy, 1159 had undergone the procedure at least 15 years before entry. During 258,892 person-years of follow-up, we documented 773 cases of MI (719 nonfatal and 54 fatal), 1907 cases of angina pectoris or coronary revascularization, and 604 confirmed cases of ischemic or hemorrhagic stroke (566 nonfatal and 38 fatal). When compared to men without prior vasectomy, the multivariate relative risk (RR) of total MI adjusted for age and other coronary risk factors was 0.94 (95% confidence interval [CI], 0.77-1.14) among men with vasectomy. Risk estimates for fatal and nonfatal events did not appreciably differ from each other. For angina or coronary revascularization or both, the multivariate relative risk was 0.99 (0.88-1.12) and for total stroke the RR was 0.95 (0.75-1.21). For men who had undergone vasectomy 15 or more years previously, the multivariate relative risks were 0.98 (0.73-1.32) for total MI, 1.17 (0.87-1.57) for total stroke, and 1.12 (0.94-1.35) for angina/revascularization. These results provide reassuring evidence that vasectomy does not materially increase the risk of subsequent cardiovascular disease, even 15 or more years following the procedure.     

Body mass index and the initial manifestation of coronary heart disease in women aged 40-59 years.

A population-based case-control study was conducted to evaluate body mass as a coronary heart disease (CHD) risk factor among women 40-59 years of age. Cases were women aged 40-59 whose first manifestation of CHD was angina (No. = 133), nonfatal myocardial infarction (No. = 90), and sudden unexpected death (No. = 18) during 1960-1982. Two randomly selected controls were matched on age and time of the initial disease manifestation of the case. The adjusted relative risk for weight and body mass index respectively demonstrated a moderate association with all CHD as well as with angina, but no association with definite CHD (myocardial infarction or sudden unexpected death). To determine if the observed association between body mass index and angina was possibly attributable to differential misclassification bias (i.e. obese women were, in contrast to non-obese women, preferentially labelled as having coronary artery disease) data for angina were stratified by confirmed versus unconfirmed cardiac origin. In the unconfirmed angina analysis, the 75th percentile for weight contrasted with the 25th percentile was associated with a 50% increase in the risk of being labelled as having angina (adjusted odds ratio (OR) = 1.59, 95% confidence interval (CI): 1.11-2.28), while a similar contrast for Quetelet Index was also associated with a nearly 2-fold increase in the risk of being labelled as having angina (adjusted OR = 1.74, 95% CI: 1.18-2.57).(ABSTRACT TRUNCATED AT 250 WORDS)     

Plasma fibrinogen and coronary heart disease in urban Japanese

There is little information on the relation of plasma fibrinogen concentration to the risk of coronary heart disease in Asians, including Japanese, whose plasma fibrinogen concentration has been reported to be low by Western standards. The authors conducted a prospective study with 4.8 years of follow-up of 11,977 men and women aged 21-89 years (mean value of fibrinogen = 267 mg/dl) living or working in Osaka, Japan, in 1990-1996 to examine the relation of plasma fibrinogen with the incidence of coronary heart disease (myocardial infarction and angina pectoris). Mean fibrinogen concentration was 293.6 mg/dl for men who developed coronary heart disease (n = 35) compared with 261.6 mg/dl for men free of coronary heart disease (n = 8,094; difference, p < 0.01), and 355.2 mg/dl for women who developed coronary heart disease (n = 6) compared with 276.8 mg/dl for women free of coronary heart disease (n = 3,842; difference, p < 0.01). With a Cox proportional hazards model to adjust for cardiovascular risk factors, the relative risk for the highest fibrinogen quartile (> or =295 mg/dl) compared with the lowest (<228 mg/dl) was 4.8 (95% confidence interval: 1.4, 16.8, p = 0.01) for coronary heart disease, and 3.8 (95% confidence interval: 1.1, 13.4, p = 0.04) for myocardial infarction. Plasma fibrinogen is useful to predict the risk of coronary heart disease among urban Japanese, whose mean plasma fibrinogen is relatively low.     

Serum triglycerides and risk of coronary heart disease among Japanese men and women

To examine the relation of triglycerides with coronary heart disease among populations with low mean total cholesterol, the authors conducted a 15.5-year prospective study ending in 1997 of 11,068 Japanese aged 40-69 years (4,452 men and 6,616 women with mean total cholesterol = 4.73 mmol/liter and 5.03 mmol/liter, respectively), initially free of coronary heart disease or stroke. There were 236 coronary heart disease events comprising 133 myocardial infarctions, 68 angina pectoris events, and 44 sudden cardiac deaths. The coronary heart disease incidence was greater in a dose-response manner across increasing quartiles of nonfasting triglycerides for both sexes. The multivariate relative risk of coronary heart disease adjusting for coronary risk factors and time since last meal associated with a 1-mmol/liter increase in triglycerides was 1.29 (95% confidence interval (CI): 1.09, 1.53; p = 0.004) for men and 1.42 (95% CI: 1.15, 1.75; p = 0.001) for women. The trend was similar for myocardial infarction, angina pectoris, and sudden cardiac death. The relation of triglycerides with coronary heart disease was not influenced materially by total cholesterol levels or, in a subsample analysis (51% of total sample), by high density lipoprotein cholesterol levels. Nonfasting serum triglycerides predict the incidence of coronary heart disease among Japanese men and women who possess low mean values of total cholesterol. Further adjustment for high density lipoprotein cholesterol suggests an independent role of triglycerides on the coronary heart disease risk.     

Childhood socioeconomic status and risk of cardiovascular disease in middle aged US women: a prospective study.

OBJECTIVE--To examine prospectively the relationship of childhood socioeconomic status and risk of cardiovascular disease in middle aged women. DESIGN--A prospective cohort of women with 14 years follow up data (1976-90). SUBJECTS--A total of 117,006 registered female nurses aged 30 to 55 years in 1976 and free of diagnosed coronary heart disease, stroke, and cancer at baseline. MAIN OUTCOME MEASURES--Incident fatal coronary heart disease, non-fatal myocardial infarction, and stroke (fatal and non-fatal). RESULTS--Low socioeconomic status in childhood was associated with a modestly increased risk of incident non-fatal myocardial infarction and total cardiovascular disease in adulthood. Compared with middle aged women from white collar childhood backgrounds, the age adjusted risk of total cardiovascular disease for women from blue collar backgrounds was 1.13 (95% CI 1.02, 1.24) and that of non-fatal myocardial infarction was 1.23 (95% CI 1.06, 1.42). No significant increase in risk was observed for stroke or fatal coronary heart disease. Adjustment for differences in family and personal past medical history, medication use, exercise, alcohol intake, diet, birth weight, being breastfed in infancy, and adult socioeconomic circumstance somewhat attenuated the increased risks observed for women from blue collar childhood socioeconomic backgrounds. In multivariate analysis, women whose fathers had been manual labourers had the highest relative risk of total coronary heart disease (RR = 1.53; 95% CI 1.09, 2.16) and non-fatal myocardial infarction (RR = 1.67; 95% CI 1.11, 2.53) when compared with women whose fathers had been employed in the professions. CONCLUSION--In this group lower childhood socioeconomic status was associated with a small but significant increase in the risk of total coronary heart disease as well as non-fatal myocardial infarction. For women from the most socioeconomically disadvantaged childhood backgrounds, the association is not explained by differences in a large number of cardiovascular risk factors, by differences in adult socioeconomic status, or by differences in indices of nutrition during gestation or infancy.     

Prevalence and correlates of angina pectoris in the Italian nine communities study. Research Group ATS-RF2 of the Italian National Research Council

We investigated the prevalence and correlates of angina pectoris in 6573 men and women aged 20-59 participating in the Italian National Multicenter Study on Risk Factors for Arteriosclerosis. In both sexes, the prevalence of angina pectoris, as assessed by the Rose questionnaire, increased sharply with age (from 0.8% to 5.1% for men and from 1.7% to 6.9% for women). In all age groups, there was a higher prevalence of angina pectoris for women than for men. In men, a strong positive association was found between angina pectoris and myocardial infarction (both by self-report and electrocardiographic documentation) and self-reported dyspnea. In women, myocardial infarction (self-reported), electrocardiographic-documented myocardial ischemia, intermittent claudication, and dyspnea were all associated with angina pectoris. In both sexes, angina pectoris was positively associated with body mass index. Males with diabetes had two times the prevalence of angina pectoris as males without diabetes; in females, diabetes was only weakly associated with angina pectoris. None of other major ischemic heart disease risk factors (blood pressure, serum lipids, or smoking) was associated with angina pectoris.     

Effect of carbon monoxide on cardiovascular disease.

Carbon monoxide exposure from heavy smoking or heavy atmospheric carbon monoxide pollution depresses myocardial function in patients with coronary heart disease, aggravates angina pectoris, aggravates intermittent claudication of the calf or thigh, increases myocardial ischemia in patients with clinical and subclinical coronary heart disease, and contributes to an increased incidence of nonfatal and fatal myocardial infarction and sudden death from coronary heart disease. Carbon monoxide contributes to the increase in nonfatal and fatal myocardial infarction and in sudden death from coronary heart disease in cigarette smokers by (a) carboxyhemoglobin interfering with myocardial oxygen delivery at the time nicotine has caused an increase in myocardial oxygen demand, aggravating an episode of myocardial ischemia, (b) the negative inotropic effect of carboxyhemoglobin aggravating an attack of myocardial ischemia, (c) carboxyhemoglobin reducing the threshold for ventricular fibrillation during an episode of myocardial ischemia, and (d) carboxyhemoglobin increasing platelet stickiness, thereby, increasing a thrombotic tendency. Furthermore, experimental data indicate that exposure to carbon monoxide in concentrations found in heavy tobacco smokers or in persons with heavy occupational exposure to carbon monoxide plays a role in the pathogenesis of cardiovascular disease.     

Does recent alcohol consumption reduce the risk of acute myocardial infarction and coronary death in regular drinkers?

This study, conducted in Auckland, New Zealand, over 2 years from March 1986, used a case-control design to investigate the hypothesis that alcohol acutely increases the risk of both nonfatal myocardial infarction and coronary death in the 24 hours after drinking, among regular drinkers. The nonfatal myocardial infarction analyses included 278 male and 60 female cases identified from a population-based coronary heart disease surveillance program and 458 male and 266 female controls randomly selected from the same population matched by age and sex. In the coronary death analyses, 172 male and 16 female coronary death cases from the same surveillance program and a population-based sample of 294 males and 165 females who were age and sex matched were examined. Information on alcohol consumption in the 24 hours before the coronary event in cases and a comparable 24-hour period in controls was collected. Study subjects all drank alcohol regularly at least once per month and were aged 25-64 years. Controls were more likely than cases to report a drinking episode in the 24-hour period examined in both sexes and for fatal and nonfatal disease. After controlling for possible confounding, the authors found that drinkers had a consistently lower estimated risk of both fatal and nonfatal coronary heart disease than participants reporting no alcohol in the previous 24 hours. The odds ratios ranged from 0.75 (95% confidence interval 0.62-0.90) for nonfatal myocardial infarction in men to 0.46 (95% confidence interval 0.19-1.10) for coronary death in women. There were no clear differences in estimated acute risk among those who drank one or two drinks, three or four drinks, or more than four drinks in the 24-hour period. These findings suggest that, contrary to previous speculation, alcohol consumption may acutely reduce coronary heart disease risk.     

冠脉钙化积分与病情及生化指标相关性的研究

目的 探讨冠心病患者应用冠脉CT血管成像术(CTA)检测的冠状动脉钙化积分(CACS)与病情及血清生化指标的相关性.方法 选取2017年9月-2019年9月在福建省立医院进行CTA检查的住院患者173例,根据具体冠心病存在与否及病情严重程度分为非冠心病组49例、心绞痛组78例、心肌梗死组46例.比较三组患者的CACS、...     

Alcoholic beverages and myocardial infarction in young men

Previous studies have suggested that people who consume a moderate amount of alcohol have a reduced risk of coronary heart disease compared with nondrinkers. This hypothesis was further tested in the period April 1980-April 1983 in a study of 2,170 men with first nonfatal myocardial infarction and 981 hospital controls, all under 55 years of age. The relative risk estimate for men who drank between one and seven times per week compared with never drinkers was 1.2 (95% confidence interval, 0.8-1.8) when age and cigarette smoking were taken into account and 1.1 (0.7-1.7) when personality type was also taken into account. There was no evidence of a reduced risk for users who drank primarily one type of alcoholic beverage (beer, wine, or liquor) or within categories of dose measured in ounces consumed per week. The findings were not materially changed when other risk factors for myocardial infarction were taken into account. The results of this study suggest that moderate alcohol consumption does not reduce the risk of nonfatal myocardial infarction.     

Rose Questionnaire angina among United States black, white, and Mexican-American women and men. Prevalence and correlates from The Second National and Hispanic Health and Nutrition Examination Surveys

The prevalence of Rose Questionnaire angina and its association with coronary heart disease risk factors and manifestations were investigated in representative samples of the US population. The study populations included 1,135 black and 8,323 white subjects aged 25-74 years examined in the Second National Health and Nutrition Examination Survey, 1976-1980, and 2,775 Mexican-American subjects aged 25-74 years examined in the Hispanic Health and Nutrition Examination Survey, Mexican-American portion, 1982-1983. Age-adjusted prevalence rates of Rose angina were similar among black, white, and Mexican-American women (6.8%, 6.3%, and 5.4%, respectively). An excess in the prevalence of Rose angina was observed in women compared with men for white and Mexican-American persons under age 55 years, but not for those over age 55. Electrocardiographic evidence of myocardial infarction and self-reported heart attack were strongly associated with prevalent Rose angina among white men and women aged 55 years and over, but not among those below age 55. Serum cholesterol, body mass index (weight (kg)/height (m)2), current cigarette smoking, and dyspnea were independently associated with an increased risk of prevalent angina in multivariate logistic models for white women, excluding those with a prior heart attack. Because many younger women with chest pain who may consult physicians are likely to have elevations in cardiovascular risk factors, their self-reported chest pain can be used as an opportunity to intervene and reduce their future risk of cardiovascular disease.     

Five-year incidence of angina pectoris and other forms of coronary heart disease in healthy men aged 50-59 in France and Northern Ireland: the Prospective Epidemiological Study of Myocardial Infarction (PRIME) Study.

BACKGROUND: The North-South gradient in myocardial infarction and coronary death rates in various western European regions has been described by the WHO MONICA Project over the last decade. The results of the 5-year follow-up of the Prospective Epidemiological Study of Myocardial Infarction (PRIME) Study reported here give the opportunity of extending the comparison to the incidence of angina pectoris in men aged 50-59 living in four regions (Belfast, Lille, Strasbourg, Toulouse) which were covered by the MONICA Project. METHODS: The PRIME Study is a multicentre cohort study with a common protocol and centralized event analysis. It included 10 600 men, of whom 9758 (7359 in France and 2399 in Belfast) were free of coronary disease at entry with 842 (496 in France and 346 in Belfast) having pre-existing coronary disease. RESULTS: In France, subjects free of coronary heart disease at baseline developed 106 cases of myocardial infarction or coronary death (2.93/1000 subjects per year) and 94 cases of angina pectoris (2.61/1000). In Belfast, 61 developed myocardial infarction or coronary death (5.24/1000) and 60 angina pectoris (5.39/1000). Hazard rate ratios for Belfast in comparison to France were respectively 1.79 (95% CI : 1.30-2.47) and 2.07 (1.49-2.86) for each class of clinical complication. CONCLUSION: Rate ratios for angina pectoris incidence between Northern Ireland and France in the PRIME Study are comparable to those for myocardial infarction or coronary death reported by the WHO MONICA Project and suggest that the North-South gradient in Europe applies to different manifestations of coronary disease.     

Prevalence of angina pectoris in Spain

The frequency of coronary heart disease in a community is usually measured by myocardial infarction incidence and mortality rates. The measurement of the prevalence of angina pectoris may, however, become a convenient way of assessing coronary heart disease morbidity in the future. The aim of this study was to determine the prevalence of angina and validity of the Rose questionnaire in the Spanish population aged from 45 to 74 years. A cross-sectional study was conducted in 10,248 subjects (45–74 years), representative of the Spanish population. The WHO Rose questionnaire was used and a construct validation against regional mortality rates and cardiovascular risk factor prevalence was devised. The overall angina prevalence increased with age both in men and women, but was higher in the latter (7.3% and 7.7%, respectively). Angina prevalence also increased with the number of cardiovascular risk factors present and correlated with regional CHD mortality rates (r = 0.66). Sensitivity and specificity results of the Rose questionnaire were low when tested against exercise test (52.9% and 52.1%, respectively). As conclusions, Rose questionnaire is a reliable tool for assessing angina prevalence in the Spanish population which is similar to that of other industrialized countries with higher myocardial infarction morbidity and mortality.     

Family income a strong predictor of coronary heart disease events but not of overall deaths among Turkish adults: a 12-year prospective study

OBJECTIVE: The objective of this study was to assess whether family income affected future deaths and coronary heart disease (CHD) events. DESIGN: A prospective population-based survey (the Turkish Adult Risk Factor study) was used. SETTING: The setting was numerous communities in all geographic regions of Turkey surveyed between 1990 and 2001/2002. SUBJECTS: The subjects were a random sample of 2704 men and women 20 years of age or over at baseline examination. METHOD: Monthly family incomes were categorized by the participants into four increasing brackets. Information on the mode of deaths was obtained from first-degree relatives and/or health personnel of the local heath office. The diagnosis of definite or suspected CHD among survivors was based on history, physical examination of the cardiovascular system, and Minnesota coding of resting ECGs. CHD event was defined as newly developed fatal or nonfatal myocardial infarction, new onset stable angina, and/or myocardial ischemia following the baseline survey. After exclusion of participants with CHD at onset, 250 deaths and 297 fatal and nonfatal CHD occurred among 2704 men and women (mean age 41.6+/-15) during a mean 10.0 years of follow-up. MAIN RESULTS: All-cause deaths failed to be significantly associated with income brackets in logistic regression analysis when adjusted for age, sex, and three major risk factors. Systolic blood pressure and cigarette smoking were significant independent predictors of overall mortality. In regard to fatal and nonfatal CHD, even after adjusting for age, sex and three major risk factors, a significant excess was noted in the two lowest brackets as opposed to the high income bracket (relative risk 1.56 and 1.75, respectively, P<0.03). CONCLUSIONS: Family income in the Turkish community was not predictive of overall mortality, but was strongly predictive of future CHD events independent of age, sex, and three major factors, posing a huge coronary risk on the individual and the society.     

Serum C-reactive protein and fibrinogen concentrations and self-reported angina pectoris and myocardial infarction: findings from National Health and Nutrition Examination Survey III

C-reactive protein may predict the risk of cardiovascular disease, but its association with angina pectoris in the general population has not been clearly established, however. We used data from National Health and Nutrition Examination Survey III conducted from 1988-1994 to examine the associations between serum C-reactive protein and plasma fibrinogen concentrations and self-reported angina pectoris and myocardial infarction among 7,948 U.S. men and women aged 40 years and older. C-reactive protein and fibrinogen concentrations were moderately correlated (r = 0.43). After adjustment for age, sex, race or ethnicity, education, smoking status, systolic blood pressure, serum cholesterol, high-density lipoprotein cholesterol, history of diabetes mellitus, body mass index, and physical activity, fibrinogen (but not C-reactive protein) concentration was significantly associated with self-reported angina pectoris. Neither fibrinogen or C-reactive protein concentrations were significantly associated with angina pectoris when entered in the model simultaneously. C-reactive protein and fibrinogen concentrations were positively associated with myocardial infarction when entered separately into models, but only C-reactive protein concentration was significantly associated with myocardial infarction when both variables were entered simultaneously. These cross-sectional data showed a significant positive association between C-reactive protein concentration and myocardial infarction but not self-reported angina pectoris in the U.S. population.     

Family history,longevity, and risk of coronary heart disease: the PRIME Study

BACKGROUND: To assess the contribution of family history of coronary heart disease (CHD) and longevity in parents to 5-year incidence of coronary events in middle-aged men. METHODS: A prospective study in men from Northern Ireland and the French cities and environs of Lille, Strasbourg, and Toulouse. A total of 10 600 men aged 50-59 years were examined between 1991 and 1994 and followed annually by questionnaire for incident cases of coronary disease. A detailed family history was taken and a quantitative family risk score for CHD was calculated for each subject. Five-year follow-up is complete; all coronary events (coronary deaths, myocardial infarction, and angina) documented by clinical records were reviewed by an independent medical committee. RESULTS: At screening, 9758 subjects were free of clinical and historical evidence of CHD; in this group there were 317 coronary events by 5 years of follow-up. Subjects whose parents had both survived until >/=80 years showed a relative odds of 0.49 (95% CI: 0.31-0.77) for risk of a coronary event compared with subjects whose parents had not survived until >/=80 years old with adjustment for age and nine other risk factors including family history. The pattern of results was similar in France and Northern Ireland, although parental survival was longer in France. Likewise, subjects with a strong family history showed a relative odds of 1.93 (95% CI: 1.25-3.00) compared with subjects without such a history, after adjustment for age and the nine risk factors including parental longevity. The pattern of results was similar in France and Northern Ireland. CONCLUSIONS: These results indicate that a family history of coronary disease and parental longevity, although related, act independently of one another and of other major cardiovascular risk factors in predicting 5-year risk of subsequent coronary events.