“…In most studies, the death rates from ischemic heart disease and stroke were not reported for each separate year of follow-up; we calculated these by multiplying the all-cause death rates by the proportions of all deaths in patients with first and subsequent MIs that were from heart disease ( Table 1, taking the excess mortality in the first year to be entirely cardiac) and that were from stroke. 9,10,15,18,19,22,23 In all 23 studies, the diagnosis of MI was based on a classic clinical history together with diagnostic electrocardiographic changes, including Q waves, ST-segment elevation, and T-wave changes, or, in patients who did not survive long enough to undergo an electrocardiogram, autopsy findings. In the 13 most recent studies, [1][2][3][4][5][6][7]15,16,[20][21][22][23][24][25][26][27][28][29][30] elevated serum concentrations of enzymes (serum aspartate transaminase and lactate dehydrogenase) were also used.…”