Utility of conventional risk factors in evaluation of patients with coronary disease

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We are uncertain about what remediable factors influence the future health and survival of coronary patients. It is clear that the amount of damage sustained by the heart and its circulation is an important determinant of survival. It is not established whether the major risk factors play an important role at this stage in the disease as they clearly do for the presymptomatic coronary candidate.

Once clinical coronary heart disease appears, the average prognosis is not encouraging.1 Following a first-recognized myocardial infarction, a man’s chances of dying within the first year (in the Framingham cohort) are about 20%. This is a mortality rate 14 times that of the cohort free of coronary heart disease. This proximate mortality includes hospital mortality and possibly some prehospital mortality, but not sudden death, which has been excluded. After surviving the first year, chances of dying in the ensuing 5 years is 23%, a rate four times that of the general population. Following this, the next 5 years carry a 25% mortality (three times the population free of coronary heart disease). Following the infarction, half will have angina, 30% developing it anew. Reinfarctions will occur at a rate of 4% per year and half the recurrences will be fatal. Congestive failure will occur at ten times, and strokes at five times the rates for the general population. The prognosis for angina pectoris is not much better. Yet, as grim as these prospects for the future might seem, the risk is not uniform and for some . . .



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