title: Typical and atypical coronary heart disease deaths and their different relationships with risk factors. The Gubbio residential cohort study.
abstract: OBJECTIVE
  The Seven Countries Study showed that fatal coronary heart disease (CHD) with only chronic heart failure, arrhythmia or blocks (atypical CHD, A-CHD) may represent a distinct disease as compared to fatal CHD cases with angina pectoris, acute myocardial infarction (AMI) or sudden death (typical CHD, T-CHD). We aimed at validating this, using identical diagnostic criteria, in a separate residential cohort first examined in 1983-85 in Gubbio, central Italy.
  
  
  METHODS
  Forced Cox's models were run to assess 9 classic risk factors and their 20-year predictivity of A-CHD versus T-CHD, in the entire cohort or separately for men and women.
  
  
  RESULTS
  There were 3229 subjects aged 30-79 years. Entry mean age was slightly higher in women than men although age at death was lower in men than in women for both T-CHD (71.99 ± 11.38 versus 81.20 ± 9.35 years, p<0.0001) and A-CHD (80.22 ± 9.44 versus 84.98 ± 8.13 years, p<0.0001). T-CHDs were predicted by male gender, age, continued smoke, systolic blood pressure (SBP), blood glucose, total and HDL-cholesterol (protective). A-CHDs were predicted by age, continued smoke, SBP, body mass index and blood glucose but neither total nor HDL-cholesterol or gender was significant. In the entire cohort and in men there were predictive differences of T-CHD versus A-CHD fatalities only in relation to age (p<0.01), SBP (p<0.05) and total cholesterol (p<0.01).
  
  
  CONCLUSIONS
  As age, SBP and total cholesterol had a different predictive role of T-CHD versus A-CHD fatalities also in the Gubbio cohort, the possibility is reinforced that a different etiology exists between these entities.
authors.affiliation: Department of Cardiovascular, Respiratory, Nephrological, Anesthesiological and Geriatric Sciences, Sapienza University of Rome, Viale del Policlinico 155, I-00161 Rome, Italy. Electronic address: paoloemilio.puddu@uniroma1.it.
authors.forename: Paolo Emilio
authors.initials: PE
authors.lastname: Puddu
authors.affiliation: Centre of Preventive Medicine, Gubbio, Italy. Electronic address: oscar.terradura@gmail.com.
authors.forename: Oscar
authors.initials: O
authors.lastname: Terradura Vagnarelli
authors.affiliation: Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy. Electronic address: mariomancini30@virgilio.it.
authors.forename: Mario
authors.initials: M
authors.lastname: Mancini
authors.affiliation: Istituto Auxologico Italiano, University of Milan, Milan, Italy. Electronic address: alberto.zanchetti@unimi.it.
authors.forename: Alberto
authors.initials: A
authors.lastname: Zanchetti
authors.affiliation: Associazione per la Ricerca Cardiologica, Via Latina 49, I-00179 Rome, Italy. Electronic address: menottia@tin.it.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Menotti
mesh_terms: D000328:Adult; D017677:Age Distribution; D000368:Aged; D001145:Arrhythmias, Cardiac / Q000378:metabolism / Q000401:mortality*; D001786:Blood Glucose / Q000378:metabolism; D001794:Blood Pressure; D008076:Cholesterol, HDL / Q000097:blood; D015331:Cohort Studies; D003327:Coronary Disease / Q000378:metabolism / Q000401:mortality*; D016757:Death, Sudden, Cardiac / Q000453:epidemiology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D012112:Residential Facilities; D012307:Risk Factors; D017678:Sex Distribution; D012907:Smoking / Q000401:mortality
chemical_list: D001786:Blood Glucose; D008076:Cholesterol, HDL
keywords: CHD fatalities; Coronary heart disease; Cox model; Gubbio Cohort Study; Prediction