title: Epidemiology of typical coronary heart disease versus heart disease of uncertain etiology (atypical) fatalities and their relationships with classic coronary risk factors.
abstract: OBJECTIVE
  The relationships were explored of some cardiovascular risk factors to typical (TYP) and atypical (ATYP) fatal coronary events (CHD).
  
  
  METHODS
  Thirteen cohorts of 40-59 year-old men of the Seven Countries Study were followed-up for 40 years (N = 9704 heart disease free subjects). Fatal TYP-CHD were classified when manifested as myocardial infarction, other acute coronary syndromes, angina pectoris and sudden death; and as ATYP-CHD when manifested only as heart failure or arrhythmia in the absence of other clear etiologies. Death rates were computed for single countries separately for TYP and ATYP and for different lengths of follow-up. Cox models included: age, smoking habits, systolic blood pressure (SBP), serum cholesterol (CHOL), forced expiratory volume in ¾ sec (FEV) and diabetes.
  
  
  RESULTS
  TYP-CHD was more common in North American and Northern European countries, while ATYP-CHD were more common in Southern and Eastern Europe. Age at death was 5 years greater for ATYP-CHD than for TYP-CHD. Cox models in the pool of 13 cohorts showed that coefficient for age was significantly larger for ATYP-CHD (hazard ratio, HR: 2.36; confidence intervals CI: 2.18 - 2.26) versus TYP-CHD (HR 1.50, CI 1.43-1.58) while coefficients for CHOL was larger and significant for TYP-CHD (HR 1.29, CI 1.22-1.35) but not for ATYP-CHD (HR 0.93, CI 0.85-1.03). SBP, smoking habits, FEV and diabetes all predicted both conditions almost equally.
  
  
  CONCLUSIONS
  The different relationships of CHOL and age with the two types of fatal CHD suggest that the two groups of manifestations may belong to different diseases.
authors.affiliation: Association for Cardiac Research, Rome, Italy. Electronic address: menottia@tin.it.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Menotti
authors.forename: Paolo Emilio
authors.initials: PE
authors.lastname: Puddu
authors.forename: Mariapaola
authors.initials: M
authors.lastname: Lanti
authors.forename: Daan
authors.initials: D
authors.lastname: Kromhout
authors.forename: Hanna
authors.initials: H
authors.lastname: Tolonen
authors.forename: Biljana
authors.initials: B
authors.lastname: Parapid
authors.forename: Bratislav
authors.initials: B
authors.lastname: Kircanski
authors.forename: Antony
authors.initials: A
authors.lastname: Kafatos
authors.forename: Hisashi
authors.initials: H
authors.lastname: Adachi
mesh_terms: D000328:Adult; D001145:Arrhythmias, Cardiac / Q000175:diagnosis* / Q000453:epidemiology* / Q000401:mortality; D015331:Cohort Studies; D003327:Coronary Disease / Q000175:diagnosis* / Q000453:epidemiology* / Q000401:mortality; D005060:Europe / Q000453:epidemiology; D005500:Follow-Up Studies; D006333:Heart Failure / Q000175:diagnosis* / Q000453:epidemiology* / Q000401:mortality; D006801:Humans; D007564:Japan / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009656:North America / Q000453:epidemiology; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects / Q000453:epidemiology
keywords: Atypical coronary heart disease; Epidemiology; Risk factors; Typical coronary heart disease