Risk factors for new coronary events in older African-American men and women.

R isk factors for new coronary events in older men and women include age,1,2 prior coronary artery disease (CAD),1,2 cigarette smoking,2–4 systolic or diastolic hypertension,1,2,5,6 diabetes mellitus,1,2 serum total cholesterol,2,3,7–9 serum high-density lipoprotein (HDL) cholesterol (inverse association),2,7,9,10 serum triglycerides,2,7 and obesity.1 We discuss the association of coronary risk factors with the incidence of new coronary events at 42-month mean follow-up in 185 older African-American men and at 48-month mean follow-up in 413 older AfricanAmerican women. • • • We investigated, in a prospective study, the association between coronary risk factors and new coronary events in 185 African-American men, mean age 78 6 9 years (range 60 to 100), and in 413 AfricanAmerican women, mean age 80 6 9 years (range 60 to 103), in a long-term health care facility. The mean follow-up period was 42 6 23 months (range 1 to 128) for men and 48 6 30 months (range 2 to 156) for women. New coronary events were diagnosed if the patient developed documented nonfatal or fatal myocardial infarction or sudden cardiac death. Myocardial infarction was diagnosed as previously described.11 Sudden cardiac death was defined as an unexpected cardiac death in a patient with heart disease found dead within 1 hour of being clinically stable.12 Patients with fatal primary ventricular fibrillation documented by electrocardiogram were classified as having sudden cardiac death. The senior investigator reviewed all coronary events with the attending physician. The risk factors evaluated were age, prior CAD, current cigarette smoking, systolic or diastolic hypertension, diabetes mellitus, obesity, serum total cholesterol, serum HDL cholesterol, and serum triglycerides. Prior CAD was diagnosed if the patient had a documented clinical history of myocardial infarction or electrocardiographic evidence of Q-wave myocardial infarction (n 5 292) or typical angina pectoris without previous myocardial infarction (n 5 6). A systolic blood pressure of $160 mm Hg on 3 occasions was considered systolic hypertension. A diastolic blood pressure of $90 mm Hg on 3 occasions was considered diastolic hypertension. Diabetes mellitus was present if the patient was receiving insulin (n 5 108) or oral hypoglycemic drugs (n 5 74) to control hyperglycemia, or if the fasting venous plasma glucose levels were $140 mg/dl on 2 occasions (n 5 26).13 The weight and height of each patient were correlated with the average height-weight table for persons aged 65 to 94 years.14 A patient was considered obese if he or she was $20% above ideal body weight. Blood was drawn after a 14-hour overnight fast for determination of serum total and HDL cholesterol and triglycerides by Smith Kline Beecham Clinical Laboratories, Inc. (Syosset, New York). For analyses comparing the 2 groups, chi-square tests were used for dichotomous variables and Student’s t tests for continuous variables (Tables I and II). The relation between prognostic variables measured at baseline and the time to the development of new coronary events was analyzed using the stepwise Cox regression model (Tables III and IV). Table I shows the association of coronary risk factors with new coronary events in 185 older African-American men. Table II shows the association of coronary risk factors with new coronary events in 413 older African-American women. Table III lists 6 significant prognostic variables for new coronary events in older African-American men and their regression coefficients in the stepwise Cox regression model. Table IV lists 7 significant prognostic variables for new coronary events in older African-American women and their regression coefficients in the stepwise Cox regression model. • • • In Los Angeles County, mortality rates from cardiovascular disease were highest for African-Americans.15 In the Beta Blocker Heart Attack Trial, African-American patients had a higher percentage of variables associated with increased mortality and a higher mortality rate than whites plus other races.16 At 16-year follow-up in the Coronary Artery Surgery Study, African-Americans had a lower survival rate