The Underlying Risk of Death After Myocardial Infarction in the Absence of Treatment

Law, Malcolm; Watt, Hilary; Wald, Nicholas

doi:10.1001/archinte.162.21.2405

Cited by 178 publications

(126 citation statements)

References 63 publications

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“…27 Law et al performed a metaanalysis using the data from the studies in which follow-up was completed by 1980, and found a 2-hold increase in mortality after discharge in patients with a history of prior MI on admission; cardiovascular mortality after hospital discharge were approximately 20% in the first year and 10% per year thereafter for those with prior MI, vs. approximately 10% in the first year and 5% per year thereafter for those without. 28 These lines of evidence suggest that, regardless of the differences in study design, year, and treatment strategy among the studies, occurrence of Re-MI remains a mortality risk in post-MI patients since decades ago. In other words, recurrence of AMI still carries a mortality risk in contemporary settings, despite recent advances in secondary prevention that have decreased mortality after AMI.…”

Section: Mortality Risk Associated With Re-mimentioning

confidence: 99%

Incidence, Predictors, and Subsequent Mortality Risk of Recurrent Myocardial Infarction in Patients Following Discharge for Acute Myocardial Infarction

Nakatani

Sakata

Suna

et al. 2013

Circ J

100

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Section: Mortality Risk Associated With Re-mimentioning

confidence: 99%

Incidence, Predictors, and Subsequent Mortality Risk of Recurrent Myocardial Infarction in Patients Following Discharge for Acute Myocardial Infarction

Nakatani

Sakata

Suna

et al. 2013

Circ J

100

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“…In calculating these, we subtracted the risk of stroke deaths from total risk of death because stroke mortality was accounted for separately in the model. Stroke events increased the immediate risk of death (case fatality rate of 14%) and the risk of death in subsequent years among stroke survivors (to 5% unless other-cause mortality derived from age-and sex-specific life tables exceeded 5%) (18,19). Figure E1 (online) shows all possible disease transitions.…”

Section: Model Overviewmentioning

confidence: 99%

Cost-Effectiveness of Carotid Plaque MR Imaging as a Stroke Risk Stratification Tool in Asymptomatic Carotid Artery Stenosis

et al. 2015

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“…In people who have survived a myocardial infarction (MI) the risk of death from CHD in the absence of treatment is about 5% per year regardless of age or risk factor levels. 12 This is an extremely high risk group in whom all interventions known to reduce reversible risk factors can reasonably be offered. Adults with diabetes mellitus have a similarly high risk of CHD and are justifiably treated by multiple risk factor reduction regardless of risk factor levels.…”

Section: Combining Coronary Risk Factors For Screeningmentioning

confidence: 99%

The future of coronary heart disease prevention

Wald

2007

Clinical Medicine

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The future of coronary heart disease prevention Risk factors like serum cholesterol and blood pressure while important in causing coronary heart disease (CHD) are poor predictors of who will and will not suffer a CHD event. Combining them does not overcome this problem, so screening for risk by measuring risk factors is not worthwhileThe best predictors of risk are a history of vascular disease or those risk factors which can not be changed (age and sex)The dose-response relations between risk factors and CHD show benefit in modifying risk factors in people at high risk, regardless of the level of the risk factor and whatever the reason for the high risk Coronary heart disease is largely preventable; a simple strategy of combination therapy to simultaneously reduce all major risk factors in everyone above a specified age (say 55) and younger people who already have vascular disease would reduce risk by over 80% Key PointsKEY WORDS: blood pressure, cholesterol, coronary heart disease, homocysteine, Polypill cholesterol-lowering treatment. The same limitations apply using systolic or diastolic BP as the screening test. 4 Combining coronary risk factors for screeningIt is often assumed that combining information on several coronary risk factors will overcome the problem that individually they are poor screening tests. 9 But this is not the case. An analysis of the BUPA cohort 10 showed that using either systolic BP or apoprotein B alone, the detection rate was 17% for a false-positive rate of 5%. Using both together, the detection rate increased to 22% (keeping the falsepositive rate fixed at 5%). Using six risk factors in combination gave a detection rate of only 28% for the same false-positive rate. The improvement in screening performance from combining several risk factors, including more recently investigated factors such as C-reactive protein and serum homocysteine, 11 is marginal and can be achieved only by identifying a large proportion who will not develop clinical CHD.Simpler and more discriminatory means of identifying people in the population at highest risk of a CHD event are needed and are available. In people who have survived a myocardial infarction (MI) the risk of death from CHD in the absence of treatment is about 5% per year regardless of age or risk factor levels. 12 This is an extremely high risk group in whom all interventions known to reduce reversible risk factors can reasonably be offered. Adults with diabetes mellitus have a similarly high risk of CHD and are justifiably treated by multiple risk factor reduction regardless of risk factor levels. 13 'Global' cardiovascular riskCardiovascular screening is sometimes used to compute 'global' cardiovascular risk in people without a history of CHD or diabetes, based on age, sex and the level of combinations of the causal cardiovascular risk factors. The risk estimate itself has become the screening variable and treatment is offered to all those whose 10-year risk exceeds a specified cut-off level (eg 20%, as advocated in recent British guideli...

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The Underlying Risk of Death After Myocardial Infarction in the Absence of Treatment

Cited by 178 publications

References 63 publications

Incidence, Predictors, and Subsequent Mortality Risk of Recurrent Myocardial Infarction in Patients Following Discharge for Acute Myocardial Infarction

Incidence, Predictors, and Subsequent Mortality Risk of Recurrent Myocardial Infarction in Patients Following Discharge for Acute Myocardial Infarction

Cost-Effectiveness of Carotid Plaque MR Imaging as a Stroke Risk Stratification Tool in Asymptomatic Carotid Artery Stenosis

The future of coronary heart disease prevention

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