Paolo Emilio Puddu1, Oscar Terradura Vagnarelli2, Mario Mancini3, Alberto Zanchetti4, Alessandro Menotti5. 1. Department of Cardiovascular, Respiratory, Nephrological, Anesthesiological and Geriatric Sciences, Sapienza University of Rome, Viale del Policlinico 155, I-00161 Rome, Italy. Electronic address: paoloemilio.puddu@uniroma1.it. 2. Centre of Preventive Medicine, Gubbio, Italy. Electronic address: oscar.terradura@gmail.com. 3. Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy. Electronic address: mariomancini30@virgilio.it. 4. Istituto Auxologico Italiano, University of Milan, Milan, Italy. Electronic address: alberto.zanchetti@unimi.it. 5. Associazione per la Ricerca Cardiologica, Via Latina 49, I-00179 Rome, Italy. Electronic address: menottia@tin.it.
Abstract
OBJECTIVES: The Seven Countries Study showed that fatal coronary heart disease (CHD) with only chronic heart failure, arrhythmia or blocks (atypical CHD, A-CHD) may represent a distinct disease as compared to fatal CHD cases with angina pectoris, acute myocardial infarction (AMI) or sudden death (typical CHD, T-CHD). We aimed at validating this, using identical diagnostic criteria, in a separate residential cohort first examined in 1983-85 in Gubbio, central Italy. MATERIAL AND METHODS: Forced Cox's models were run to assess 9 classic risk factors and their 20-year predictivity of A-CHD versus T-CHD, in the entire cohort or separately for men and women. RESULTS: There were 3229 subjects aged 30-79 years. Entry mean age was slightly higher in women than men although age at death was lower in men than in women for both T-CHD (71.99 ± 11.38 versus 81.20 ± 9.35 years, p<0.0001) and A-CHD (80.22 ± 9.44 versus 84.98 ± 8.13 years, p<0.0001). T-CHDs were predicted by male gender, age, continued smoke, systolic blood pressure (SBP), blood glucose, total and HDL-cholesterol (protective). A-CHDs were predicted by age, continued smoke, SBP, body mass index and blood glucose but neither total nor HDL-cholesterol or gender was significant. In the entire cohort and in men there were predictive differences of T-CHD versus A-CHD fatalities only in relation to age (p<0.01), SBP (p<0.05) and total cholesterol (p<0.01). CONCLUSION: As age, SBP and total cholesterol had a different predictive role of T-CHD versus A-CHD fatalities also in the Gubbio cohort, the possibility is reinforced that a different etiology exists between these entities.
OBJECTIVES: The Seven Countries Study showed that fatal coronary heart disease (CHD) with only chronic heart failure, arrhythmia or blocks (atypical CHD, A-CHD) may represent a distinct disease as compared to fatal CHD cases with angina pectoris, acute myocardial infarction (AMI) or sudden death (typical CHD, T-CHD). We aimed at validating this, using identical diagnostic criteria, in a separate residential cohort first examined in 1983-85 in Gubbio, central Italy. MATERIAL AND METHODS: Forced Cox's models were run to assess 9 classic risk factors and their 20-year predictivity of A-CHD versus T-CHD, in the entire cohort or separately for men and women. RESULTS: There were 3229 subjects aged 30-79 years. Entry mean age was slightly higher in women than men although age at death was lower in men than in women for both T-CHD (71.99 ± 11.38 versus 81.20 ± 9.35 years, p<0.0001) and A-CHD (80.22 ± 9.44 versus 84.98 ± 8.13 years, p<0.0001). T-CHDs were predicted by male gender, age, continued smoke, systolic blood pressure (SBP), blood glucose, total and HDL-cholesterol (protective). A-CHDs were predicted by age, continued smoke, SBP, body mass index and blood glucose but neither total nor HDL-cholesterol or gender was significant. In the entire cohort and in men there were predictive differences of T-CHD versus A-CHD fatalities only in relation to age (p<0.01), SBP (p<0.05) and total cholesterol (p<0.01). CONCLUSION: As age, SBP and total cholesterol had a different predictive role of T-CHD versus A-CHD fatalities also in the Gubbio cohort, the possibility is reinforced that a different etiology exists between these entities.