CLASSICAL RISK-FACTORS AND THEIR IMPACT ON INCIDENT NONFATAL AND FATAL MYOCARDIAL-INFARCTION AND ALL-CAUSE MORTALITY IN SOUTHERN GERMANY - RESULTS FROM THE MONICA AUGSBURG COHORT STUDY 1984-1992

Background The MONICA (Monitoring Trends and Determinants in Cardiovas cular Diseases) project in Augsburg provides the first population-base d cohort study in Germany to quantify the associations of the risk fac tors hypertension, hypercholesterolaemia and smoking with incident non -fatal and fatal myocardial infarction and all-cause mortality, and to assess their impact at the population level. Methods The cohort compr ises 1074 men and 1013 women aged 45-64 years; they were followed over 8 years from 1984-1992. In the men, there were 61 non-fatal and fatal myocardial infarctions and 92 all-cause mortality events over this pe riod; in the women the number of deaths from all causes was 45. Incide nce rates, hazard rate ratios, population attributable fractions and r ate advancement periods were calculated. Results Adjusting for confoun ders, the myocardial infarction hazard rate ratios for men with hypert ension, or a total cholesterol/HDL-cholesterol ratio greater than or e qual to 5.5, or smoking greater than or equal to 20 cigarettes/day, we re 2.0 (95% CI 1.2-3.5), 2.9 (95% CI 1.7-5.0), and 2.7 (95% confidence interval (CI) 1.4-5.0), respectively. The risk factor combination tot al cholesterol/HDL cholesterol ratio greater than or equal to 5.5 and cigarette smoking was particularly hazardous. The three risk factors c ontributed 65% of the burden of myocardial infarction in the populatio n. The rate advancement period for myocardial infarction associated wi th hypertension, total cholesterol/HDL cholesterol ratio greater than or equal to 5.5 or smoking greater than or equal to 20 cigarettes/day was 8.3, 12.4 and 11.5 years, respectively. In women, these risk facto rs were similarly predictive of all-cause mortality. Comparing the coh ort data from Augsburg with those of two occupational cohorts from Ger many reveals higher absolute myocardial infarction risks in the Augsbu rg population; however, the relative risk estimates in the Augsburg an d the two occupational cohorts were very similar. Conclusion Our resul ts confirm the important contribution of the classical risk factors to the risk of myocardial infarction and all-cause mortality in Germany. The results pertaining to the concept of rate advancement periods par ticularly demonstrate the great potential for prevention.