Abstract 16665: Traditional Risk Factors and Acute Coronary Syndrome Free Survival

Abstract

Introduction: Recent studies claim that the discriminatory power of traditional risk factors (RF) in predicting acute events and mortality from coronary heart disease (CHD) is low. This claim implies a potential misinterpretation, which may negatively affect healthcare organizations Aim: To investigate the association between the four traditional RF, hypertension, current smoking, hypercholesterolemia and diabetes, and the lifetime occurrence of first acute coronary syndrome (ACS) and consequent mortality Methods: We analysed data of 70953 Caucasian patients presenting with first ACS, but without prior CHD enrolled in the ISACS Archives. RF were used to stratify patients into mutually exclusive categories using a balancing strategy by inverse probability weighting. Trends were evaluated by the Pearson's correlation coefficient (r). Primary endpoints were patient’ age at hospital presentation for ACS and rates of all-cause mortality within 30 days after hospital admission Results: For fatal ACS (n=6097), exposure to at least one RF ranged from 77.6% in women to 74.5% in men. The presence of all four RF significantly (P trend<0.001) decreased the age at time of ACS event by nearly half a decade compared with the absence of any RF in both women (from 67.1 to 61.9 years) and men (from 62.8 to 58.9 years). Similar trends were observed for fatal ACS among women (from 73.3 to 67.6 years) and men (from 69.3 to 63.2 years). Current smoking (ORs 4.17 in women; 3.00 in men) and hypercholesterolemia (ORs 1.34 in women; 1.44 in men) were the predominant RFs for premature ACS presentation, with diabetes being the largest for death from premature ACS (ORs 1.50 in women; 1.65 in men). In contrast, there was an inverse association between the presence of RFs and the risk of 30-day mortality. The risk ratios (RR) among individuals with at least one RF vs those with no RFs were 0.72 (95%CI 0.65-0.79) in women and 0.64 (95%CI 0.59-0.70) in men. This association was consistent among patient subgroups Conclusions: In contrast with recent thinking, the presence of traditional RFs is associated with very high lifetime risk of developing ACS and markedly shorter survival. Public health policies should still place significant emphasis on traditional RFs and the lifestyle behaviors causing them