Risk of coronary events by baseline factors during 28 years follow-up and three periods in a random population sample of men.

Abstract. Wilhelmsen L, Lappas G, Rosengren A(Cardiovascular Institute, Go¨teborg University,Go¨teborg, Sweden). Risk of coronary events bybaseline factors during 28 years follow-up andthree periods in a random population sample ofmen. J Intern Med 2004; 256: 298–307.Aims. To investigate the predictive value of riskfactors for coronary events measured in midlifeduring three separate periods over a follow-up periodextending through 28 years.Methods. A total of 7437 men aged 47–55 yearsand free of myocardial infarction at baseline wereexamined. Risk of coronary events (nonfatalmyocardial infarction and coronary deaths) wasanalysed for the entire period and for 0–15, 16–21and 22–28 years’ follow-up, using age-adjusted andmultiple Cox regression analyses.Results. Age, diabetes, elevated blood pressure andserum cholesterol were all independently associatedwith increased risk of coronary events for theentire 28 years as well as for each of the periods.A family history of coronary events amongstfathers, mothers and siblings was independentlysignificant for the entire follow-up period, and therisk did not decline with extended follow-up.Effort-related chest pain was a strong andindependent risk factor for the first 21 years butnot thereafter. The importance of smokingdecreased over time and was not significantlyassociated with outcome during the last period.Stress was also significant for the entire 28 years,but in selected periods only up to 21 years. Bodymass index, low physical activity and low socialclass were inconsistently or not at all related tooutcome in multiple analyses.Keywords: coronary heart disease, family history,long-term follow-up, risk factors, stress.