Predictors of cardiac and noncardiac mortality among 14,697 patients with coronary heart disease

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Abstract

The decrease in mortality from ischemic heart disease during the last 25 years may partly reflect improvement in diagnosis and treatment of patients with coronary heart disease. These patients, therefore, are experiencing morbidity and mortality due to other causes. The aim of our study was to describe the incidence and causes of cardiac mortality (CM) and noncardiac mortality (NCM) and to identify predictive factors. A cohort of 14,697 patients with coronary heart disease was merged with the Central Population Registry to identify mortality records from 1990 to 1996. Among the 1,839 deaths, 1,055 (57.4%) were cardiac, 626 (34.0%) were noncardiac, and 158 deaths (8.6%) were due to unknown causes as classified in the International Classification of Diseases–Ninth Edition (ICD). The 3 most significant predictors were age for a 10-year increment (odds ratios 1.75 and 2.25 for CM and NCM, respectively), chronic obstructive pulmonary disease (odds ratios 1.67 and 1.71), and current smoking (odds ratios 1.29 and 1.66). A history of cancer was a predictor of NCM, but not of CM, whereas peripheral vascular disease predicted CM but not NCM. As the number of predictive factors increased from none to ≥5, the risk of NCM gradually increased from 1.9% to 15.5%. Similar predictors expose subjects with coronary disease to CM and NCM, but smoking plays a more pronounced role in the prediction of NCM, whereas past myocardial infarction, lower levels of high-density lipoprotein cholesterol, and peripheral vascular disease are mainly associated with CM. Because of the similarity of antecedent predictors, treatment of risk factors among patients with coronary heart disease should prove valuable for the prevention of all-cause mortality.

Section snippets

Study population

Between February 1990 and October 1992, 15,502 patients with coronary artery disease, aged 45 to 74 years, from 18 cardiology departments throughout Israel, were screened for participation in a randomized placebo-controlled, secondary prevention trial—The Bezafibrate Infarction Prevention (BIP) study. Of these patients, 3,122 fulfilled the inclusion criteria (included group) and took part in the trial,7 which was aimed at evaluating the effectiveness of a lipid-modifying drug, bezafibrate, in

Baseline and clinical characteristics

During the follow-up period, 1,839 subjects died. We analyzed the cohort according to 3 groups: survivors (n = 12,858), CM (n = 1,055), and NCM (n = 626). A separate group of 158 deaths (8.6%) was excluded from the analysis due to death from unknown causes. Mean follow-up for the CM group was 2.7 ± 1.7 years, for the NCM group, mean follow-up was 3.2 ± 1.7 years, and for the 12,858 survivors, mean follow-up was 5.5 ± 0.8 years.

Among the patients who died, 269 participated in the BIP study (n =

Discussion

Over the mean 5.15-year follow-up period of this cohort, 1,839 coronary patients died. This represents a death rate of 2,275/100,000/year, which is 2.2 times higher than the mortality rate of Israelis aged 44 to 74 years in 1994 (the mid follow-up year of the study), which was 1,104/100,000/year.12 Because survival of patients with coronary heart disease following acute myocardial infarction has improved, these patients are increasingly exposed to other causes of death. Life expectancy at birth

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