ASSOCIATION BETWEEN CORONARY RISK FACTORS, CORONARY ARTERY LESIONS, AND SURVIVAL

The relationship between cardiovascular risk factors and coronary artery disease (CAD) was studied in 9878 patients undergoing coronary arteriography. The smoking history of patients with CAD was compared to that of controls for each of 9 anatomic locations using a case-control method. The odds ratio (OR) estimate of relative risk of CAD for smokers to nonsmokers was greater for right coronary artery stenosis (OR = 5.8) than for circumflex artery (OR = 3.5), or left anterior descending artery (OR = 2.1). The risk of CAD for diabetics relative to nondiabetics increased with increasing severity of diabetes. The risk was highest for insulindependent diabetes (OR = 3.0). Serum cholesterol> 6.07 mmol/L and systolic blood pressure> 140 mm Hg were both associated with a significant increase in risk. The odds ratio estimates of the relative risk of significant coronary artery disease for women who were using estrogen after menopause relative to those who were not was 0.4. The relative risk in current estrogen users remained the same after adjustment for age, cigarette smoking, diabetes, cholesterol, and hypertension. These data indicate that post-menopausal use of estrogen reduces the risk of angiographically significant coronary artery disease, that cigarette smoking is associated particularly with lesions of the right coronary artery, that the risk of CAD increases proportionately with the severity of diabetes mellitus and that diabetes mellitus, elevated serum cholesterol, and high systolic blood pressure are associated with significant stenosis of the proximal, mid, and distal segments of all major coronary arteries.