title: Fatality of future coronary events is related to inflammation-sensitive plasma proteins: a population-based prospective cohort study.
abstract: BACKGROUND
  Approximately 40% of men suffering a first acute coronary event die the first day; most of them never reach hospital. It is largely unknown whether a low-grade inflammation in healthy men predicts the fatality of future coronary events.
  
  
  RESULTS
  Five inflammation-sensitive plasma proteins (ISPs; fibrinogen, orosomucoid, alpha(1)-antitrypsin, haptoglobin, and ceruloplasmin) were measured in 6075 apparently healthy men, 680 of whom had a first coronary event [nonfatal myocardial infarction (MI) or death from coronary heart disease (CHD)] over a mean follow-up of 19 years. Of the 680 men who had a coronary event, 197 died the first day and 228 died within 28 days. Elevated ISPs were significantly associated with both nonfatal MI and CHD death, but the relative risks for CHD death were higher than for nonfatal MI. Among men who subsequently had a coronary event, the proportion of fatal events was related to the number of elevated ISPs at the baseline examination. The proportions who died the first day were 26%, 25%, 29%, and 35%, respectively, among men with 0, 1, 2, and > or =3 elevated ISPs (trend: P=0.01, adjusted for risk factors). The corresponding proportions who died within 28 days were 30%, 31%, 34%, and 38%, respectively (trend: P=0.03).
  
  
  CONCLUSIONS
  Men who have been exposed to a low-grade inflammation many years earlier have higher fatality in future coronary events, with a higher proportion of CHD deaths and less nonfatal MI. This relation should be regarded when inflammatory markers are considered for risk assessment in primary prevention.
authors.affiliation: Department of Community Medicine, Malmö University Hospital, S-20502 Malmö, Sweden. gunnar.engstrom@smi.mas.lu.se
authors.forename: Gunnar
authors.initials: G
authors.lastname: Engström
authors.forename: Bo
authors.initials: B
authors.lastname: Hedblad
authors.forename: Lars
authors.initials: L
authors.lastname: Stavenow
authors.forename: Patrik
authors.initials: P
authors.lastname: Tydén
authors.forename: Peter
authors.initials: P
authors.lastname: Lind
authors.forename: Lars
authors.initials: L
authors.lastname: Janzon
authors.forename: Folke
authors.initials: F
authors.lastname: Lindgärde
mesh_terms: D000209:Acute-Phase Proteins / Q000032:analysis*; D000328:Adult; D015331:Cohort Studies; D003327:Coronary Disease / Q000401:mortality*; D005500:Follow-Up Studies; D006801:Humans; D007249:Inflammation / Q000097:blood; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology / Q000401:mortality*; D011446:Prospective Studies; D012307:Risk Factors; D016019:Survival Analysis
chemical_list: D000209:Acute-Phase Proteins