PROGNOSTIC ROLE OF CARDIOVASCULAR RISK-FACTORS FOR MEN WITH CARDIOMEGALY (THE REYKJAVIK STUDY)

The Reykjavik Study is a large population-based cohort study, starting in 1967. A total of 9,139 men, born in the years 1907 to 1934, have b een followed for 4 to 24 years. Heart size was determined by chest roe ntgenogram in 2 planes and cardiomegaly, defined as a relative heart s ize exceeding 550 ml/m(2), was detected in 517. Multivariate Cox regre ssion analysis was used to estimate the independent contribution of va riables measured at each participant's first visit to the risk of both all-cause and coronary artery disease (CAD) mortality. Cardiomegaly w as detected in 3.7% of men aged <40 years and in 21.2% of those >75 ye ars. One half of these men had hypertension, one third had manifestati ons of CAD, and 37% had neither. Among men with cardiomegaly, the pres ence of CAD had marked deleterious effect on prognosis. Serum total ch olesterol and systolic blood pressure were significant independent ris k factors of CAD mortality with risk ratio of 1.008 per mg/dl serum ch olesterol (95% confidence interval 1.00 to 1.01; p=0.004) and 1.015/mm Hg (95% confidence interval 1.000 to 1.300; p=0.043), respectively. S moking >25 cigarettes/day carried a 2.3-fold risk (95% confidence inte rval 1.3 to 4.4; p=0.008) of all-cause mortality. The traditional risk factors for CAD, serum cholesterol, high blood pressure, and smoking maintain their detrimental effect on prognosis among patients with car diomegaly. These findings have implications for secondary prevention, signifying that in the presence of cardiomegaly, complacency is not ju stified in controlling major risk factors for CAD. (C) 1996 by Excerpt a Medica, Inc.