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Serum Cholesterol as a Prognostic Factor after Myocardial Infarction: The Framingham Study

Nathan D. Wong, PhD; Peter W. F. Wilson, MD; and William B. Kannel, MD
[+] Article, Author, and Disclosure Information

This paper was presented in part at the XI World Congress of Cardiology, Manila, The Phillipines, February 1990.

Requests for Reprints: Nathan Wong, PhD, Preventive Cardiology Program, C240 Medical Sciences 1, University of California, Irvine, CA 92717.

Current Author Addresses: Dr. Wong: Preventive Cardiology Program, C240 Medical Sciences 1, University of California, Irvine, CA 92717.

Drs. Wilson and Kannel: The Framingham Heart Study, 5 Thurber Street, Framingham, MA 01701.

Ann Intern Med. 1991;115(9):687-693. doi:10.7326/0003-4819-115-9-687
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Objective: To determine the relation between serum cholesterol levels and the long-term risk for reinfarction, death from coronary heart disease, and all-cause mortality in persons who recover from myocardial infarction.

Design: Prospective, longitudinal study.

Setting: A geographically defined population-based cohort of adults participating in the Framingham Heart Study.

Patients: Men (n = 260) and women (n =114), 33 to 88 years of age (mean age, 62 years), who had a history of myocardial infarction.

Measurements: A complete physical examination, including electrocardiographic evaluation, blood pressure measurement, height and weight measurements, determination of smoking habits, and casual determinations of blood glucose and serum cholesterol, was done approximately 1 year after recovery from initial myocardial infarction. Patients were followed after infarction for the occurrence of reinfarction or death (mean follow-up, 10.5 years; range, 0.8 to 31.6 years).

Main Results: The mean cholesterol level after infarction was 5.21 mmol/L (242.8 mg/dL); 20% of patients had levels below 5.17 mmol/L (200 mg/dL), and 22% had levels of 7.11 mmol/L (275 mg/dL) or more. Compared with patients who had cholesterol levels below 5.17 mmol/L, patients with levels of 7.11 mmol/L or more were at increased risk for reinfarction (relative risk, 3.8; 95% Cl, 1.6 to 8.7), death from coronary heart disease (relative risk, 2.6; Cl, 1.4 to 4.8), and all-cause mortality (relative risk, 1.9; Cl, 1.2 to 2.9) based on multivariate Cox regression analyses adjusted for other coronary risk factors. Intermediate cholesterol levels (5.17 mmol/L to 7.11 mmol/L) were generally not associated with increased risk. The association between elevated serum cholesterol and increased risk was strongest in men; however, elevated cholesterol levels were found to be most strongly related to death from coronary disease and to all-cause mortality in persons who were 65 years of age or more.

Conclusions: Patients who have recovered from a myocardial infarction and who have high cholesterol levels are at an increased long-term risk for reinfarction, death from coronary heart disease, and all-cause mortality. Our results confirm the prognostic value of cholesterol levels measured after myocardial infarction and support the role of lipid management in this population.





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