Fatality of future coronary events is related to inflammation-sensitive plasma proteins: a population-based prospective cohort study.
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.
Engström
Gunnar
G
Department of Community Medicine, Malmö University Hospital, S-20502 Malmö, Sweden. gunnar.engstrom@smi.mas.lu.se
Hedblad
Bo
B
Stavenow
Lars
L
Tydén
Patrik
P
Lind
Peter
P
Janzon
Lars
L
Lindgärde
Folke
F
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
D000209:Acute-Phase Proteins