Risk Factors for Long-Term Coronary Prognosis After Initial Myocardial Infarction: The Framingham Study

The role of standard coronary heart disease risk factors in predicting the long-term risk of recurrent coronary events in survivors of myocardial infarction is examined. Of 697 subjects (464 males and 233 females) who experienced an initial myocardial infarction during 30 years of follow-up in the Framingham Study, 459 returned for a baseline examination and were followed for up to 32 years (mean = 9.7 years) for incident reinfarction or coronary death. The Cox proportional hazards model was used to evaluate the relation of postinfarction risk factors with reinfarction and coronary death. Age-adjusted analyses showed the risk of reinfarction to be positively associated with blood pressure and serum cholesterol. Risk of coronary death was strongly associated with blood sugar level, systolic blood pressure, serum cholesterol, heart rate, diabetes, and interim reinfarction. In multivariable analyses, systolic pressure, serum cholesterol, and diabetes were predictive of reinfarction; relative weight was inversely associated with reinfarction. Systolic pressure, serum cholesterol, and the prevalence of diabetes persisted as independent predictors of coronary death. When adjustments were made for the effects of these variables, women were at only half the risk of coronary death compared with men. Higher baseline risk factors in women compared with men may obscure an important survival advantage in women. In persons recovered from an initial myocardial infarction, standard risk factors, particularly systolic pressure, serum cholesterol, and diabetes, remain important determinants of coronary prognosis over many years and warrant attention in preventing subsequent events.