Risk factors measured in middle-aged men predicting coronary events in geriatric age

OBJECTIVES: To explore the duration of the predictive power of major coronary risk factors measured on a single occasion in middle aged men for the occurrence of coronary heart disease (CHD) incidence and mortality during 50years of follow-up. MATERIAL AND METHODS: In the Italian Rural Areas of the Seven Countries Study1677 CHD-free men aged 40-59 were enrolled in 1960 and age, cigarette smoking, systolic blood pressure and serum cholesterol were measured. During 50years of follow-up 1641 men died, 451 had a major fatal or non-fatal CHD event (incidence) and 263 died from CHD. Five partitioned Cox proportional hazards models were computed, one for each independent and subsequent 10-year period. Five 10-year partitioned hazard scores, derived from multivariable coefficients, were cumulated for each risk factor and plotted against time. RESULTS: The resulting curves showed increasing time trends for CHD incidence and mortality as a function of cigarette smoking, systolic blood pressure and serum cholesterol for the first 30-40years followed by a decline in the association that was more evident for serum cholesterol. The curves fit straight lines with large correlation coefficient ranging 0.82 to 0.99. The loss of predictive power after 30-40years was confirmed in a model covering 50years of follow-up and including the interaction term of risk factors/time. CONCLUSION: A single measurement of major coronary risk factors is associated with CHD incidence and mortality for at least 30-40years of follow-up, entering the gerontologic age.