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
Why the study?
Does elevated serum cholesterol increase the risk of coronary death in middle-aged men with and without prior coronary disease?
Population
7,100 men aged 51 to 59 years at baseline, including 314 with clinical angina but no myocardial infarction…
Comparison
High serum cholesterol (≥7.2 mmol/L) vs Low serum cholesterol (≤5.2 mmol/L)
Design
Cohort
Follow-up
16 years
Authors
Discussion
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Implication
Suggests amplified cholesterol-related coronary mortality in men with prior disease; extends observational data but leaves causality and practice change open.
Key Points
- To compare the prognostic significance of serum cholesterol levels on long-term coronary mortality among men with prior myocardial infarction, men with angina pectoris, and men free of coronary disease.
- Followed 7,100 men aged 51 to 59 years from the Primary Prevention Study in Göteborg, Sweden, over 16 years from baseline in 1974–1977.
- Identified 314 men with clinical angina without myocardial infarction, 195 survivors of myocardial infarction, and healthy controls without baseline coronary disease.
- Evaluated coronary death rates across serum cholesterol categories (≤5.2 vs. ≥7.2 mmol/L), adjusting for age, smoking, systolic blood pressure, BMI, and diabetes.
- Coronary mortality per 1,000 observation years for cholesterol ≥7.2 vs. ≤5.2 mmol/L was 8.5 vs. 2.7 in healthy men, 31.0 vs. 5.5 in men with angina, and 58.3 vs. 19.8 in prior myocardial infarction.
- Adjusted relative risk of coronary death for cholesterol ≥7.2 vs. ≤5.2 mmol/L was 2.42 (95% CI, 1.66–3.51) in healthy men, 4.82 (95% CI, 1.44–16.09) in men with angina, and 4.07 (95% CI, 1.86–8.91) in combined coronary disease.
- Sixteen-year overall survival in men with prior myocardial infarction was 50% for those with low cholesterol compared to 21% for those with high cholesterol.
Structured PICO
Does elevated serum cholesterol increase the risk of coronary death in middle-aged men with and without prior coronary disease?
P
Population
7,100 men aged 51 to 59 years at baseline, including 314 with clinical angina but no myocardial infarction, 195 who survived a myocardial infarction, and the remainder without clinical coronary disease.
I
Intervention
High serum cholesterol (≥7.2 mmol/L)
C
Comparator
Low serum cholesterol (≤5.2 mmol/L)
O
Outcome
Coronary deathhard clinical
Elevated serum cholesterol is associated with a significantly increased long-term risk of coronary death, particularly in men with pre-existing coronary disease.
Cite This Study
Rosengren et al. (1997) studied this question.