Premorbid predictors of death at initial presentation of coronary heart disease in the Women’s Health Initiative study

Background Premorbid health traits that predispose to a fatal initial presentation of coronary heart disease (CHD) remain poorly characterized. Methods We followed 148,230 post-menopausal participants in the Women’s Health Initiative for a median of 13.3 years. We ascertained the first occurrence of CHD and performed a joint Cox multivariate regression to identify premorbid predictors for a fatal rather than a non-fatal incident event. Results A total of 10,714 incident CHD events including 513 fatal events accrued during follow up. A five-year increase in age, smoking 5 to 34 cigarettes per day, and a standard deviation (SD) increase in the Cornel voltage product on electrocardiography each independently increased the relative risk (RR) of dying from one’s initial presentation of CHD by 46% (95% confidence interval [CI], 35 to 58%), 30% (8 to 51%,), and 17% (7 to 28%), respectively. A high level of recreational physical activity (>1200 metabolic equivalent (MET) minutes per week) reduced one’s relative risk by 32% (12 to 49%). A significant dose-response effect was observed for both physical activity and smoking and the reduction in absolute risk of presenting with fatal CHD associated with a healthy lifestyle was roughly equivalent to the difference in risk observed among women separated in age by approximately 10 years. Conclusions Modifiable factors affect a post-menopausal woman’s risk of dying from her initial presentation of CHD. Our findings may reduce case-fatality rates of CHD by motivating individuals at risk to adopt and/or adhere to established primary prevention strategies.