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Objectives: This study sought to evaluate long-term predictors of coronary events in men and women with arteriographically defined coronary artery disease (CAD)., Background: There is conflicting evidence of the role of triglycerides (TGs) as a prognosticator of CAD, and no studies have examined the long-term outcome of "normal" levels in predicting new coronary events., Methods: This was a retrospective cohort study that evaluated 740 consecutive patients presenting for diagnostic coronary arteriography between 1977 and 1978. Beginning in 1988, patients with arteriographic CAD (n=350) were recontacted and asked to complete detailed medical questionnaires. Case and control patients were stratified by development of new coronary events, including death from ischemic heart disease, nonfatal myocardial infarction and revascularization., Results: There were 199 events during the 18-year follow-up period. The mean high density lipoprotein cholesterol (HDL-C) was significantly lower (35 vs. 39 mg/dl; p=0.002) and TGs higher (160 vs. 137 mg/dl; p=0.03) in case patients than in control patients; After adjusting for age, gender and beta-adrenergic blocking agent use, multiple logistic regression analysis revealed the following independent predictors of CAD events: diabetes mellitus (relative risk [RR] 2.1, 95% confidence interval [CI] 1.4% to 3.1%), HDL-C <35 mg/dl (RR 1.5, 95% CI 1.1% to 2.00) and TGs >100 mg/dl (RR 1.5, 95% CI 1.1% to 2.1%). A Kaplan-Meier analysis revealed significantly reduced survival from CAD events in patients with baseline TG levels > or = 100 mg/dl compared with TG levels <100 mg/dl (p=0.008)., Conclusions: TG levels previously considered "normal" are predictive of new CAD events. The cutpoints established by the National Cholesterol Education Program for elevated TGs (>200 mg/dl) may need to be refined.

An epidemiologic study of idiopathic dilated cardiomyopathy was carried out in order to identify possible risk factors for this often fatal cause of heart failure in young adults. Possible associations with black race and other genetic and environmental factors were examined by comparing newly diagnosed cases ascertained from four Baltimore hospitals (n = 95) with neighborhood controls (n = 95), matched on sex and 5-year age intervals. Matched and unmatched relative odds and conditional logistic regression coefficients were obtained to describe the associations. Statistically significant, independent associations were observed between idiopathic dilated cardiomyopathy and black race, low annual income, and history of asthma (p less than 0.05). The black predominance (relative odds = 2.7, 95% confidence interval 2.0-3.4) was not explained by income, alcohol consumption, cigarette usage, body mass index, hypertension, or asthma. A possible interactive effect was observed between black race and history of asthma and other atopic diseases. Thus, blacks, especially those with a history of hypersensitivity, may represent a high-risk subgroup in need of preventive care or early intervention.

There is now substantial scientific evidence that patients with coronary heart disease (CHD) have a high prevalence of hypercholesterolemia and stand to benefit significantly from efforts to lower cholesterol levels. To evaluate physician practice patterns and attitudes concerning cholesterol assessment and management of patients hospitalized with an admitting diagnosis of CHD, one-month medical record audits were performed during 1983, 1984, and 1985, and a physician survey was administered in early 1986. Medical records of 154 inpatients hospitalized with a diagnosis of CHD before 60 years of age showed that, on the average, 18% had lipid profiles ordered and 11% received a low-fat diet in the hospital. The admission history and follow-up notes mentioned the presence or absence of lipid abnormalities in 53% of CHD inpatients. No significant changes occurred from 1983 to 1985. Survey results from 184 hospital staff physicians caring for these patients showed that less than half believed that a reduction in blood cholesterol lowers risk for heart disease in middle-aged patients with CHD. Interns and residents indicated less confidence in the efficacy of cholesterol-lowering diet and drug therapy than did attending physicians. The implications of these findings for physician training are discussed in light of recent studies of the efficacy of cholesterol lowering in secondary prevention.