RELATIONSHIP OF SOME RISK-FACTORS WITH TYPICAL AND ATYPICAL MANIFESTATIONS OF CORONARY HEART-DISEASE

Background: This analysis explores whether 'typical' clinical manifest ations of coronary heart disease (CHD) such as myocardial infarction a nd sudden death, relate to major cardiovascular risk factors in the sa me way as the 'atypical' manifestations, e,g. heart failure and chroni c arrhythmias. Patients and Methods: Sixteen cohorts of men aged 40-59 in seven countries were examined, risk factors measured (age, systoli c blood pressure, serum cholesterol and smoking habits) and 25-year mo rtality data collected in a systematic way. Cohorts were located in th e US (n = 1), Finland (n = 2), the Netherlands (n = 1), Italy (n = 3), former Yugoslavia (n = 5), Greece (n = 2) and Japan (n = 2), with a t otal of 12,763 individuals. Ecological analysis based on regression eq uations and correlation among cohorts, and individual analyses based o n proportional hazard models in pools of cohorts were conducted with t ypical and atypical CHD deaths as dependent variables. Results: The ec ological analysis suggests a significant relationship of populational mean levels of serum cholesterol and of systolic blood pressure to age -adjusted death rates from typical CHD manifestations. The relationshi ps for atypical CHD deaths were not statistically significant. In the ecological approach with multivariate analysis, none of the risk facto rs showed relevant associations with event rates, except serum cholest erol and typical CHD deaths, The ecological relationship of serum chol esterol to atypical CHD death rates was negative but not significant. On average, mean age at death was statistically higher among atypical CHD than typical CHD patients (70.2 vs. 65.8 years). In the individual multivariate analysis conducted on pools of countries, the relationsh ip of risk factors with typical CHD deaths was direct and significant for age, systolic blood pressure, and smoking habits in Northern Europ e and America and Southern Europe, but only for systolic blood pressur e and smoking habits in Japan, whereas for atypical CHD, the predictiv e factors were age, systolic blood pressure and cigarette smoking in N orthern Europe and America and Southern Europe, but only age in Japan. Conclusions: The usual relationship of blood pressure and smoking hab its and the differential relationship of serum cholesterol with atypic al CHD (negative or absent) versus typical CHD (direct and significant ) could be explained by 'two different diseases' or by a mix of poorly classified conditions among the atypical cases.