Abstract
The probability of myocardial infarction developing over five years in a group of middle aged men was predicted with knowledge of their ages, blood pressures, cholesterol concentrations, and smoking habits as recorded in an initial screening examination. Although the top 15% of the risk distribution predicted 115 (32%) of the subsequent cases of myocardial infarction, there was a considerable overlap in predicted risk between those subjects who did and those who did not go on to develop a myocardial infarction. Of the subjects in the top 15% of risk, only 72 (7%) of those initially free of coronary heart disease and 43 (22%) of those initially with coronary heart disease actually developed a myocardial infarction over the subsequent five years. Thus, although a group of subjects at high risk can be identified, among whom will be a high proportion of potential victims of heart attack, many subjects will be wrongly classified. These findings may explain part of the difficulty in persuading patients of the potential benefits of reducing risks and highlight the need for research to improve the prediction of the development of coronary heart disease.
Full text
PDFSelected References
These references are in PubMed. This may not be the complete list of references from this article.
- Brand R. J., Rosenman R. H., Sholtz R. I., Friedman M. Multivariate prediction of coronary heart disease in the Western Collaborative Group Study compared to the findings of the Framingham study. Circulation. 1976 Feb;53(2):348–355. doi: 10.1161/01.cir.53.2.348. [DOI] [PubMed] [Google Scholar]
- Castelli W. P., Doyle J. T., Gordon T., Hames C. G., Hjortland M. C., Hulley S. B., Kagan A., Zukel W. J. HDL cholesterol and other lipids in coronary heart disease. The cooperative lipoprotein phenotyping study. Circulation. 1977 May;55(5):767–772. doi: 10.1161/01.cir.55.5.767. [DOI] [PubMed] [Google Scholar]
- Kannel W. B. Some lessons in cardiovascular epidemiology from Framingham. Am J Cardiol. 1976 Feb;37(2):269–282. doi: 10.1016/0002-9149(76)90323-4. [DOI] [PubMed] [Google Scholar]
- Keys A., Aravanis C., Blackburn H., Van Buchem F. S., Buzina R., Djordjevic B. S., Fidanza F., Karvonen M. J., Menotti A., Puddu V. Probability of middle-aged men developing coronary heart disease in five years. Circulation. 1972 Apr;45(4):815–828. doi: 10.1161/01.cir.45.4.815. [DOI] [PubMed] [Google Scholar]
- Kornitzer M., De Backer G., Dramaix M., Kittel F., Thilly C., Graffar M., Vuylsteek K. Belgian heart disease prevention project: incidence and mortality results. Lancet. 1983 May 14;1(8333):1066–1070. doi: 10.1016/s0140-6736(83)91908-6. [DOI] [PubMed] [Google Scholar]
- Krueger D. E., Ellenberg S. S., Bloom S., Calkins B. M., Jacyna R., Nolan D. C., Phillips R., Rios J. C., Sobieski R., Shekelle R. B. Risk factors for fatal heart attack in young women. Am J Epidemiol. 1981 Apr;113(4):357–370. doi: 10.1093/oxfordjournals.aje.a113104. [DOI] [PubMed] [Google Scholar]
- Oliver M. F. Should we not forget about mass control of coronary risk factors? Lancet. 1983 Jul 2;2(8340):37–38. doi: 10.1016/s0140-6736(83)90016-8. [DOI] [PubMed] [Google Scholar]
- Rose G., Hamilton P. S., Keen H., Reid D. D., McCartney P., Jarrett R. J. Myocardial ischaemia, risk factors and death from coronary heart-disease. Lancet. 1977 Jan 15;1(8003):105–109. doi: 10.1016/s0140-6736(77)91701-9. [DOI] [PubMed] [Google Scholar]
- Rose G., Heller R. F., Pedoe H. T., Christie D. G. Heart disease prevention project: a randomised controlled trial in industry. Br Med J. 1980 Mar 15;280(6216):747–751. doi: 10.1136/bmj.280.6216.747. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Rose G., Tunstall-Pedoe H. D., Heller R. F. UK heart disease prevention project: incidence and mortality results. Lancet. 1983 May 14;1(8333):1062–1066. doi: 10.1016/s0140-6736(83)91907-4. [DOI] [PubMed] [Google Scholar]
- Truett J., Cornfield J., Kannel W. A multivariate analysis of the risk of coronary heart disease in Framingham. J Chronic Dis. 1967 Jul;20(7):511–524. doi: 10.1016/0021-9681(67)90082-3. [DOI] [PubMed] [Google Scholar]
- Wilhelmsen L., Wedel H., Tibblin G. Multivariate analysis of risk factors for coronary heart disease. Circulation. 1973 Nov;48(5):950–958. doi: 10.1161/01.cir.48.5.950. [DOI] [PubMed] [Google Scholar]