title: Ranking of psychosocial and traditional risk factors by importance for coronary heart disease: the Copenhagen City Heart Study.
abstract: OBJECTIVE
  To rank psychosocial and traditional risk factors by importance for coronary heart disease.
  
  
  RESULTS
  The Copenhagen City Heart Study is a prospective cardiovascular population study randomly selected in 1976. The third examination was carried out from 1991 to 1994, and 8882 men and women free of cardiovascular diseases were included in this study. Events were assessed until April 2013. Forward selection, population attributable fraction, and gradient boosting machine were used for determining ranks. The importance of vital exhaustion for risk prediction was investigated by C-statistics and net reclassification improvement. During the follow-up, 1731 non-fatal and fatal coronary events were registered. In men, the highest ranking risk factors for coronary heart disease were vital exhaustion [high vs. low; hazard ratio (HR) 2.36; 95% confidence interval (CI), 1.70-3.26; P < 0.001] and systolic blood pressure (≥160 mmHg or blood pressure medication vs. <120 mmHg; HR 2.07; 95% CI, 1.48-2.88; P < 0.001). In women, smoking was of highest importance (≥15 g tobacco/day vs. never smoker; HR 1.74; 95% CI, 1.43-2.11; P < 0.001), followed by vital exhaustion (high vs. low; HR 2.07; 95% CI, 1.61-2.68; P < 0.001). Vital exhaustion ranked first in women and fourth in men by population attributable fraction of 27.7% (95% CI, 18.6-36.7%; P < 0.001) and 21.1% (95% CI, 13.0-29.2%; P < 0.001), respectively. Finally, vital exhaustion significantly improved risk prediction.
  
  
  CONCLUSIONS
  Vital exhaustion was one of the most important risk factors for coronary heart disease, our findings emphasize the importance of including psychosocial factors in risk prediction scores.
authors: The Copenhagen City Heart Study, Frederiksberg Hospital, Nordre Fasanvej 57, Copenhagen DK-2000, Denmark peter@schnohr.dk.
authors: Peter
authors: P
authors: Schnohr
authors: The Copenhagen City Heart Study, Frederiksberg Hospital, Nordre Fasanvej 57, Copenhagen DK-2000, Denmark.
authors: Jacob L
authors: JL
authors: Marott
authors: The Copenhagen City Heart Study, Frederiksberg Hospital, Nordre Fasanvej 57, Copenhagen DK-2000, Denmark.
authors: Tage S
authors: TS
authors: Kristensen
authors: The Copenhagen City Heart Study, Frederiksberg Hospital, Nordre Fasanvej 57, Copenhagen DK-2000, Denmark.
authors: Finn
authors: F
authors: Gyntelberg
authors: The Copenhagen City Heart Study, Frederiksberg Hospital, Nordre Fasanvej 57, Copenhagen DK-2000, Denmark National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark.
authors: Morten
authors: M
authors: Grønbæk
authors: The Copenhagen City Heart Study, Frederiksberg Hospital, Nordre Fasanvej 57, Copenhagen DK-2000, Denmark Department of Respiratory Medicine, Hvidovre Hospital and Section of Social Medicine, Institute of Public Health, University of Copenhagen, Copenhagen, Denmark.
authors: Peter
authors: P
authors: Lange
authors: The Copenhagen City Heart Study, Frederiksberg Hospital, Nordre Fasanvej 57, Copenhagen DK-2000, Denmark.
authors: Magnus T
authors: MT
authors: Jensen
authors: The Copenhagen City Heart Study, Frederiksberg Hospital, Nordre Fasanvej 57, Copenhagen DK-2000, Denmark Department of Cardiology, Hvidovre Hospital, Copenhagen, Denmark.
authors: Gorm B
authors: GB
authors: Jensen
authors: The Copenhagen City Heart Study, Frederiksberg Hospital, Nordre Fasanvej 57, Copenhagen DK-2000, Denmark Department of Cardiology, Bispebjerg University Hospital, Copenhagen, Denmark.
authors: Eva
authors: E
authors: Prescott
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003327:Coronary Disease / Q000453:epidemiology / Q000209:etiology*; D003718:Denmark / Q000453:epidemiology; D005221:Fatigue / Q000453:epidemiology / Q000209:etiology; D005260:Female; D006801:Humans; D006937:Hypercholesterolemia / Q000150:complications / Q000453:epidemiology; D006973:Hypertension / Q000150:complications / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects / Q000453:epidemiology; D012959:Socioeconomic Factors; D055815:Young Adult
keywords: Coronary heart disease; Ranking of risk factors; Vital exhaustion