The natural history of coronary heart disease was studied in 2789 men who had sustained at least one myocardial infarction (MI) at least 3 months previously and who were in New York Heart Association functional class I or II. All were enrolled in the Coronary Drug Project (CDP) between 1966 and 1969 and were allocated to receive placebo medication during a 5-year follow-up period. Forty characteristics determined at entry were selected for univariate and multivariate analysis, with four end points: death from all causes, sudden cardiovascular death, coronary death, and coronary death or definite nonfatal myocardial infarction. The baseline characteristics included demographic, historical, clinical, biochemical and electrocardiographic data. The mean age at the time of enrollment was 52.4 years, and the median interval since the last myocardial infarction was 1.98 years. During 5 years of follow-up, 591 men (21.2%) died from all causes. In general, the baseline characteristics that were statistically more related to subsequent mortality were those that reflected the amount of myocardial damage and loss of ventricular function. The 10 baseline variables that were most strongly related to death from all causes were ST-segment depression on the resting ECG, use of diuretics, New York Heart Association functional class, ventricular conduction defects, heart rate, cardiomegaly on chest x-ray, number of myocardial infarctions, history of intermittent claudication, serum cholesterol and white blood cell count. Baseline cholesterol and smoking at baseline were positively related to the risk of all four end points, whereas serum triglyceride was not related to 5-year prognosis in univariate analyses and was inversely related by multivariate analyses. There was a possible weak association between moderate or vigorous physical activity and decreased mortality during the next 5 years. The findings suggest a potential benefit of lowering serum cholesterol and cessation of cigarette smoking even after recovery from one or more MIs. The characteristics identified in this study as having the greatest prognostic significance are useful for evaluating the predictive value and cost/benefit ratio of other noninvasive and invasive techniques.
ASJC Scopus subject areas
- Cardiology and Cardiovascular Medicine
- Physiology (medical)