Serum cholesterol and long-term prognosis in middle-aged men with myocardial infarction and angina pectoris: A 16-year follow-up of the Primary Prevention Study in Gateborg, Sweden

OBJECTIVE: To compare the role of serum cholesterol in the long-term prognosisof men with a history of myocardial infarction, in men withclinical angina without myocardial infarction, and men withoutclinical coronary disease. METHODS: In the second screening of the Primary Prevention Study in Göteborgwhich comprised 7100 men aged 51 to 59 years at baseline in1974–1977, 314 men with clinical angina but no myocardialinfarction at baseline were identified and 195 men who had surviveda myocardial infarction for 0 to 19 years (median 3 years). RESULTS: Of the men without clinical coronary disease at baseline andcholesterol at or below 5·2 mmol .1^–1, 2·7per 1000 observation years died from coronary disease comparedto 8·5 per 1000 of the men with serum cholesterol of7·2 mmol .1^–1 or more. Corresponding figures formen with angina was 5·5 and 31·0 per 1000 observationyears, and for men with prior myocardial infarction 19·8and 58·3 respectively, per 1000. After adjustment forage, smoking, systolic blood pressure, body mass index and diabetesthe risk of coronary death in men with serum cholesterol above7·2 mmol .1^–1 compared to below 5·2 mmol.1^–1 was 2·42 (1·66–3·51) inhealthy men, 4·82 (1·44–16·09) inmen with angina, 2·70 (0·95–7·67)in survivors of myocardial infarction, and 4·07 (1·86–8·91)in the combined group of men with either angina or prior infarction.The strongest effect was seen during the first half of the follow-up,with an adjusted relative risk for high in relation to low serumcholesterol of 8·08 (1·95–33·55)in men with preexisting coronary disease. Non-coronary deathsvaried little by serum cholesterol or coronary disease statusat baseline. After 16 years, 76% of the healthy men with lowcholesterol and 65% of healthy men with cholesterol above 7·2mmol. 1^–1 were still alive. Of the men with prior myocardialinfarction, 50% in the group with low cholesterol were aliveafter 16 years, as compared to 21% of those with high cholesterol. CONCLUSION: The long-term absolute risk of death in men with coronary diseaseand elevated serum cholesterol is very high. Implementationof lipid-lowering strategies shown to be efficacious is importantin this high-risk group.