"Unwarranted survivals" and "anomalous deaths" from coronary heart disease: prospective survey of general population

McConnachie, A. , Hunt, K., Emslie, C., Hart, C.L. and Watt, G.C.M. (2001) "Unwarranted survivals" and "anomalous deaths" from coronary heart disease: prospective survey of general population. British Medical Journal, 323(7327), pp. 1487-1491. (doi: 10.1136/bmj.323.7327.1487)

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Publisher's URL: http://dx.doi.org/10.1136/bmj.323.7327.1487

Abstract

<b>Objectives</b> To assess survival in people who are at apparent high risk who do not develop coronary heart disease ("unwarranted survivals") and mortality in people at low risk who die from the disease ("anomalous deaths") and the extent to which these outcomes are explained by other, less visible, risk factors. <p></p> <b>Design</b> Prospective general population survey. <p></p> <b>Setting</b> Renfrew and Paisley, Scotland. Participants: 6068 men aged 45-64 years at screening in 1972-6, allocated to "visible" risk groups on the basis of body mass index and smoking. <p></p> <b>Main outcome measures</b> Survival and death from coronary heart disease by age 70 years. <p></p> <b>Results</b> Visible risk was a good predictor of mortality: 13% (45) of men at low risk and 45% (86) of men at high risk had died by age 70 years. Of these deaths, 12 (4%) and 44 (23%), respectively, were from coronary heart disease. In the group at low visible risk other less visible risk factors accounted for increased risk in 83% (10/12) of men who died from coronary heart disease and 29% (84/292) of men who survived. In the high risk group 81/107 who survived (76%) and 19/44 (43%) who died from coronary heart disease had lower risk after other factors were considered. Different risk factors modified risk (beyond smoking and body mass index) in the two groups. Among men at low visible risk, poor respiratory function, diabetes, previous coronary heart disease, and socioeconomic deprivation modified risk. Among men at high visible risk, height and cholesterol concentration modified risk. <p></p> <b>Conclusions</b> Differences in survival between these extreme risk groups are dramatic. Health promotion messages would be more credible if they discussed anomalies and the limits of prediction of coronary disease at an individual level.

Item Type:Articles
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:Hart, Dr Carole and Hunt, Professor Kathryn and McConnachie, Professor Alex and Watt, Professor Graham and Emslie, Dr Carol
Authors: McConnachie, A., Hunt, K., Emslie, C., Hart, C.L., and Watt, G.C.M.
Subjects:R Medicine > RC Internal medicine
College/School:College of Medical Veterinary and Life Sciences > Institute of Health and Wellbeing > Robertson Centre
College of Medical Veterinary and Life Sciences > Institute of Health and Wellbeing > Public Health
College of Medical Veterinary and Life Sciences > Institute of Health and Wellbeing > MRC/CSO SPHSU
College of Medical Veterinary and Life Sciences > Institute of Health and Wellbeing > General Practice and Primary Care
College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing > Centre for Population and Health Sciences
College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing > Clinical Specialities
Research Group:Midspan
Journal Name:British Medical Journal
Journal Abbr.:BMJ
Publisher:BMJ Publishing Group
ISSN:0959-535X
ISSN (Online):1756-1833
Copyright Holders:Copyright © 2001 BMJ Publishing Group
First Published:First published in British Medical Journal 323(7327):1487-1491
Publisher Policy:Reproduced in accordance with the copyright policy of the publisher.

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