Natural history of myocardial infarction in the coronary drug project: Long-term prognostic importance of serum lipid levels

Abstract

The relation between baseline fasting serum lipid levels (serum cholesterol and triglycerides) and 5 year rates for four end points—mortality from all causes, mortality from coronary heart disease, sudden death due to coronary heart disease and incidence of nonfatal myocardlal infarction plus coronary death—was studied in 2,789 men. These were patients in the Coronary Drug Project placebo group who were 30 to 64 years old on entry and had recovered from one or more previous documented myocardial infarctions. Serum cholesterol was significantly related to all four end points, in both univarlate and multivariate regression analyses (with control of 38 or 39 other factors in the latter). This significant relation of cholesterol to these end points was shown at low, medium and high levels of serum triglycerides. In contrast, baseline fasting serum triglyceride levels were not positively related to any of these end points. In these postmyocardial infarction patients, findings indicative of cardiovascular status at baseline evaluation, particularly the state of the myocardium, were more powerful prognosticators than serum cholesterol. These findings underscore the importance of efforts to prevent the first coronary episode. They also indicate the possibility after recovery from acute myocardial infarction of improving long-term prognosis through reduction of serum cholesterol.