性别对急性心肌梗死患者住院预后的影响

目的 探讨性别是否为影响急性心肌梗死(AMI)患者住院病死率的独立危险因素.方法 对1501例男性和635例女性AMI患者进行回顾性研究,比较不同性别患者的临床特征、住院治疗和并发症发生率,并对可能影响AMI患者住院病死率的因素进行多因素回归分析.结果 与男性相比,女性患者年龄较大,高血压和糖尿病患病率较高(分别为52.1%比41.1%,35.4%比17.3%,均P<0.01),入院时血清总胆固醇>4.68 mmol/L和心功能≥KillipⅢ级者较多(分别为71.3%比55.0%,11.7%比5.1%,均P<0.01).男性患者吸烟史多于女性(69.4%比15.7%).女性患者急性期再灌注治疗率低于男性(22.2%比31.5%,P<0.01),住院期间β受体阻滞剂和调脂药的使用率也明显低于男性(分别为64.6%比71.2%,P=0.003;43.1%比48.0%,P=0.041).女性患者住院病死率高于男性(11.7%比6.3%,P<0.01).多因素回归分析显示年龄、高血压、糖尿病、高脂血症、心功能Killip分级、再灌注治疗和β受体阻滞剂的使用率为影响AMI患者住院预后的独立危险因素,性别未进入logistic回归方程.结论 女性AMI患者住院病死率明显高于男性,造成这一差异的原因在于女性患者年龄较大,伴随危险因素多,急性期再灌注治疗率和B受体阻滞剂的使用率明显低于男性.     

糖尿病急性心肌梗死早期病死率性别差异的探讨

目的 探讨性别对糖尿病急性心肌梗死(AMI)早期病死率的影响及其原因。资料与方法 分析181例AMI:男95例,年龄(67.86±11.18)岁,其中糖尿病50例;女86例,年龄(75.08±6.78)岁,其中糖尿病46例。对男女患者住院30d病死率、年龄、血糖、血脂、从症状出现至就诊时间、溶栓及介入治疗进行比较。结果 女性AMI病死率高于男性(27.91％vs 12.63％),糖尿病AMI病死率高于非糖尿病(25.00％vs 14.12％),糖尿病AMI女性病死率高于男性(36.96％vs 14.00％),女性糖尿病AMI年龄较大,空腹血糖、甘油三酯高于男性,出现症状至入院时间较长,溶栓治疗与介入治疗较少,以上因素进行多因素回归分析发现性别、出现症状至入院时间与糖尿病急性心肌梗死早期病死率有关。结论 女性急性心肌梗死病死率高于男性,尤其是糖尿病急性心肌梗死。     

女性急性心肌梗死114例临床特点分析

目的比较女性急性心肌梗死（AMI）患者的危险因素、临床特征、预后与男性患者的不同。方法选择2000年5月-2008年5月我院连续收治的女性AMI患者114例为女性组,选择同期住院男性AMI 337例为对照组,两组从年龄、吸烟史、高血压史、糖尿病史、左室射血分数（EF值）、病死率进行比较。结果与男性相比,女性患者危险因素包括年龄大、患高血压、糖尿病、心力衰竭发生率均高于男性,典型胸痛症状发生率低于男性,病死率高于男性（P〈0．05）。结论女性AMI危险因素多,临床表现多样化,不典型,预后差。重视和提高对女性AMI的认识,采取有效措施干预,降低女性AMI发生率及病死率。     

糖尿病对急性心肌梗死住院病死率的影响

目的:探讨糖尿病是否为影响急性心肌梗死(AMI)患者住院病死率的独立危险因素。方法:回顾分析2136例AMI患者,根据是否并发糖尿病分为2组,比较2组患者的临床特征、住院治疗和并发症发生率,并对可能影响AMI患者住院病死率的因素进行多因素回归分析。结果:与非糖尿病组相比,糖尿病组患者年龄较大[(65.5±10.3)比(62.4±11.8)岁,P<0.01],空腹血糖较高[(10.4±3.2)比(5.6±1.2)mmol/L,P<0.01],女性较多(46.4%比24.8%,P<0.01),多伴有高血压(49.9%比42.8%,P<0.01)和血脂异常(63.9%比58.7%,P<0.05),心功能≥KillipⅢ级者较多(11.3%比5.8%,P<0.01),急性期再灌注治疗率(22.3%比30.6%,P<0.01)和住院期间β受体阻滞剂的使用率(64.5%比70.6%,P<0.05)较低。糖尿病组患者住院病死率显著高于非糖尿病组(14.4%比5.9%,P<0.01)。多因素回归分析显示,年龄、高血压、糖尿病、空腹血糖、血脂异常、心功能Killip分级、再灌注治疗和β受体阻滞剂的使用率均为影响AMI患者住院病死率的独立危险因素。结论:糖尿病是影响AMI患者住院病死率的独立危险因素。     

不同年龄组急性心肌梗死患者冠状动脉病变特点及危险因素分析

目的 研究不同年龄组急性心肌梗死(AMI)患者的危险因素及冠状动脉病变特点.方法 系统回顾性分析225 例不同年龄(分为青年组、壮年组、老年组)AMI 患者的危险因素及冠状动脉造影资料.结果 青年组AMI 危险因素以吸烟(与壮年组及老年组比较P＜0.05)及血脂异常为主;壮年组在此基础上增加高血压危险;老年组糖尿病是重要的危险因素.老年女性糖尿病发病率(35.1%)明显上升;梗死相关动脉狭窄程度各年龄组差异均有统计学意义(P＜0.05);临界病变(50%～75%狭窄)壮年组最多;重度狭窄(76%～95%狭窄)的概率随年龄增加而增加,分别为18.8%、38.4%和43.4%;成角和钙化病变老年组概率升高,与壮年组比较差异有统计学意义(P＜0.01).结论 吸烟、血脂异常、高血压、糖尿病等冠心病危险因素在不同年龄组男性和女性AMI 患者所占比重不同.随年龄增高,冠状动脉多支、复杂病变多见,不同年龄段应该采取相应的防治措施.     

不同性别急性心肌梗死患者预后影响因素分析

目的 观察不同性别急性心肌梗死(AMI)患者的临床特征及预后,分析影响预后的因素.方法 入选2003-2004年我院住院的sT段抬高AMI患者904例,并随访728例,根据性别分为两组,共随访4.5年.结果 与男性相比,女性入院时合并糖尿病及高血压病者多,左室射血分数(LVEF)低,成功再灌注率低(P<0.05),住院期间病死率明显高于男性.随访期间女性坚持应用β受体阻滞剂明显少于男性,病死率及因再次AMI、心力衰竭再住院率显著高于男性(P<0.05).多因素分析显示性别是住院期间病死率的独立影响因素(OR=2.130,95%CI 0.954～4.754,P=0.045),但不是远期预后的独立影响因素.结论 多种因素导致女性AMI患者的预后差,重视女性的临床特征,积极干预危险因素才能够改善预后.     

女性急性冠状动脉综合征患者危险因素及住院期间不良事件的分析

目的:探讨女性急性冠状动脉综合征(ACS)患者的危险因素及住院期间不良事件的分析。方法:分析急性冠状动脉事件全球注册(GRACE)研究中登记的明确诊断为ACS的住院313例女性患者的病例资料,与857例男性患者的危险因素及预后进行比较。结果:1.女性ACS患者合并糖尿病、高血压的比例大,2组比较差异有统计学意义(P<0.05)。2.女性患者并发症多,预后较男性差,2组比较差异有统计学意义(P<0.05)。3.应用Logistic回归分析影响女性ACS患者住院期间不良预后的危险因素为发病年龄、糖尿病及高血压,而男性住院期间不良预后的危险因素为发病年龄及体质量指数。结论:女性ACS患者较男性ACS患者危险因素多,预后差。     

原发性高血压对急性心肌梗死患者住院预后的影响

目的 探讨原发性高血压是否为影响急性心肌梗死(AMI)患者住院病死率的独立危险因素.方法 回顾分析2136例AMI患者,比较原发性高血压和非原发性高血压组患者的临床特征、住院治疗和并发症发生率,并对可能影响AMI患者住院病死率的因素进行多因素回归分析.结果 与无原发性高血压组相比,原发性高血压组患者年龄较大(64.6±10.6比61.8±12.2岁, P<0.01),女性较多(34.9%比25.6%,P<0.01),多伴有糖尿病(25.5%比20.5%,P<0.01)和高血脂症(63.3%比57.2%,P<0.01),有吸烟史者较少(47.8%比58.0%,P<0.01),住院期间抗血小板药物的使用率较低(97.0%比98.7%,P<0.01),β受体阻滞剂、血管紧张素转换酶抑制剂(ACEI)或血管紧张素受体拮抗剂(ARB)类药物的使用率较高(分别为73.6%比65.7%,P<0.01;80.1%比76.2%,P=0.032).原发性高血压组患者住院病死率显著高于无原发性高血压组(10.3%比5.9%,P<0.01).多因素回归分析显示年龄、原发性高血压、糖尿病、高血脂症和β受体阻滞剂的使用率均为影响AMI患者住院病死率的独立危险因素.结论 原发性高血压是影响AMI患者住院病死率的独立危险因素.     

性别对老年急性心肌梗死患者住院死亡的影响

目的探讨性别对老年急性心肌梗死(AMI)患者住院病死率的影响。方法选择在解放军总医院第六医学中心心血管内科住院的老年AMI患者605例,男性382例,女性223例,收集入选者基线资料、院内结局等临床资料,以院内死亡为终点构建多因素logistic回归模型。结果老年AMI患者住院病死率为9.1%。女性住院心源性死亡、高血压、糖尿病、甲状腺功能减退比例明显高于男性,血红蛋白、血肌酐、血尿酸、估算肾小球滤过率(eGFR)水平明显低于男性,TG、TC、LDL-C、HDL-C、随机血糖水平明显高于男性(P0.05,P0.01)。性别、年龄、KillipⅢ～Ⅳ级、血钾5.5 mmol/L、血钾3.5 mmol/L、血尿酸357μmol/L、eGFR60 ml/(min·1.73 m~2)、PCI及冠状动脉旁路移植术为老年AMI患者院内心源性死亡的独立危险因素(P0.05,P0.01)。ST段抬高型心肌梗死、血运重建是影响老年女性AMI患者院内死亡的独立危险因素(95%CI:1.037～13.914,P=0.044;95%CI:0.058～0.708,P=0.012)。结论性别是影响老年AMI患者住院病死率的独立危险因素。     

糖尿病对老年急性心肌梗死患者住院病死率的影响

目的探讨糖尿病是否为影响老年急性心肌梗死（AMI）患者住院病死率的独立危险因素。方法回顾分析1414例老年AMI患者，根据是否合并糖尿病分为两组，比较两组患者的临床特征、住院治疗和并发症发生率，并对可能影响老年AMI患者住院病死率的因素进行多因素回归分析。结果糖尿病组患者女性较多，多伴有高血压和高脂血症，心功能≥KiuipⅢ级者较多，急性期再灌注治疗率较低。糖尿病组患者住院病死率显著高于非糖尿病组（16．5％VS8．6％，P〈0．001）。多因素回归分析显示高血压、糖尿病、心功能Killip分级、再灌注治疗均为影响AMI患者住院病死率的独立危险因素。结论糖尿病是影响AMI患者住院病死率的独立危险因素。     

Prevalence of coronary heart disease in Scotland: Scottish Heart Health Study

Data from 10,359 men and women aged 40-59 years from 22 districts in the Scottish Heart Health Study were used to describe the prevalence rates of coronary heart disease in Scotland in 1984-1986 and their relation to the geographical variation in mortality in these districts. Prevalence was measured by previous history, Rose chest pain questionnaire, and the Minnesota code of a 12 lead resting electrocardiogram. The prevalence of coronary heart disease in Scotland was high compared with studies from other countries that used the same standardised methods. A history of angina was more common in men (5.5%) than in women (3.9%), though in response to the Rose questionnaire 8.5% of women and 6.3% of men reported chest pain. A history of myocardial infarction was three times more common in men than women, as was a Q/QS pattern on the electrocardiogram. There were significant correlations between the different measures of coronary prevalence. District measures of angina correlated well with mortality from coronary heart disease, and these correlations tended to be stronger in women than in men. There was no significant correlation between mortality from coronary heart disease and measures of myocardial infarction. The study provides data on the prevalence of coronary heart disease in men and women that are valuable for the planning of cardiological services.     

Prevalence of coronary heart disease in Scotland: Scottish Heart Health Study.

Data from 10,359 men and women aged 40-59 years from 22 districts in the Scottish Heart Health Study were used to describe the prevalence rates of coronary heart disease in Scotland in 1984-1986 and their relation to the geographical variation in mortality in these districts. Prevalence was measured by previous history, Rose chest pain questionnaire, and the Minnesota code of a 12 lead resting electrocardiogram. The prevalence of coronary heart disease in Scotland was high compared with studies from other countries that used the same standardised methods. A history of angina was more common in men (5.5%) than in women (3.9%), though in response to the Rose questionnaire 8.5% of women and 6.3% of men reported chest pain. A history of myocardial infarction was three times more common in men than women, as was a Q/QS pattern on the electrocardiogram. There were significant correlations between the different measures of coronary prevalence. District measures of angina correlated well with mortality from coronary heart disease, and these correlations tended to be stronger in women than in men. There was no significant correlation between mortality from coronary heart disease and measures of myocardial infarction. The study provides data on the prevalence of coronary heart disease in men and women that are valuable for the planning of cardiological services.     

Gender differences in acute myocardial infarction in the era of reperfusion (the MITRA registry)

There is conflicting information about gender differences in presentation, treatment, and outcome after acute ST elevation myocardial infarction (STEMI) in the era of thrombolytic therapy and primary percutaneous coronary intervention. From June 1994 to January 1997, we enrolled 6,067 consecutive patients with STEMI admitted to 54 hospitals in southwest Germany in the Maximal Individual TheRapy of Acute myocardial infarction (MITRA), a community-based registry. Women were 9 years older than men, more often had hypertension, diabetes mellitus, and congestive heart failure, and had a history of previous myocardial infarction less often. Women had a longer prehospital delay (45 minutes), had anterior wall infarction more often (odds ratio [OR] 1.21; 95% confidence interval [CI] 1.08 to 1.36), and received reperfusion therapy less often (OR 0.83; 95% CI 0.74 to 0.94). The percentage of patients who were eligible for thrombolysis and received no reperfusion was higher in women (OR 1.7; 95% CI 1.56 to 1.89). Women had recurrent angina (OR 1.45; 95% CI 1.23 to 1.71) and congestive heart failure (OR 1.26; 95% CI 1.01 to 1.56) more often. There was a trend toward a higher hospital mortality in women (age-adjusted OR 1.16, 95% CI 0.99 to 1.35; multivariate OR 1.21, 95% CI 0.96 to 1.51), but there was no gender difference in long-term mortality after multivariate analysis (age-adjusted OR 0.95, 95% CI 0.78 to 1.15; multivariate OR 0.93, 95% CI 0.72 to 1.19). Thus, women with STEMI receive reperfusion therapy less often than men. They experience recurrent angina and congestive heart failure more often during their hospital stay. The age-adjusted long-term mortality is not different between men and women, but there is a trend for a higher short-term mortality in women.     

Prevalence of nonfatal coronary heart disease among American adults

BACKGROUND: Few national estimates of the prevalence of coronary heart disease in the United States are available. METHODS: By using data from the Third National Health and Nutrition Examination Survey (1988 to 1994), we estimated prevalence of angina pectoris by questionnaire, self-reported myocardial infarction, and electrocardiographically (ECG)-defined myocardial infarction. RESULTS: Among participants aged >/=40 years who attended the medical examination, the age-adjusted prevalence of angina pectoris, self-reported myocardial infarction, and ECG-defined myocardial infarction were 5.8% of 9255, 6.7% of 9250, and 3.0% of 8206 participants, respectively. Among participants aged >/=65 years compared with those aged 40 to 64 years, the prevalence of a self-reported myocardial infarction was more than 3 times higher and that of ECG-defined myocardial infarction more than 4 times higher. The prevalences of self-reported myocardial infarction and ECG-defined myocardial infarction, but not angina pectoris, were higher among men than women. Among women, prevalence of angina pectoris and self-reported myocardial infarction were highest among blacks; among men, these coronary heart diseases were somewhat higher among whites. Prevalence of ECG-defined myocardial infarction were similar for all 3 race or ethnicity groups in either sex. The age-adjusted prevalence of coronary heart disease defined by the presence of any of these conditions was 13.9% among men and 10.1% among women. CONCLUSIONS: Although the management of coronary heart disease has improved during the past 2 decades, it remains an important prevalent disease burden among adults.     

Patterns of referral and recovery in women and men undergoing coronary artery bypass grafting.

This study compares women and men undergoing coronary artery bypass grafting. Factors before and after coronary surgery were examined to identify variables related to mortality and morbidity. The study population included 465 women and 465 men matched for age (mean age 64.2 years) who underwent first time isolated coronary artery bypass grafting between 1983 and 1988. There were higher incidences of systemic hypertension, diabetes mellitus, postmyocardial infarction angina, thyroid gland disease, arthritis (p less than 0.001 for all), acute myocardial infarction (p = 0.03), congestive heart failure (p = 0.03), and emergency surgery (p = 0.02) in women, whereas more men had peptic ulcer disease (p less than 0.001). The in-hospital death rate was not significantly different (women 4.3% vs men 3.7%). For all subjects, emergency surgery (p less than 0.001), significant left main narrowing (p less than 0.05) and renal disease (p less than 0.001) were related to death, whereas history of myocardial infarction (p less than 0.05) and diabetes (p less than 0.05) were related to death only in men. Age and body surface area were not related to death. After surgery men had a higher incidence of atrial arrhythmia (p less than 0.001), and women had a higher incidence of congestive heart failure (p less than 0.001). Although women did not have a higher mortality rate, the data suggest that women and men do not share all the same predictors of mortality after surgery.     

Gender differences and in-hospital mortality in patients undergoing percutaneous coronary interventions

BACKGROUND: Many observational and randomised studies have suggested that women are referred for invasive diagnostics and treatment of coronary artery disease (CAD) less frequently than men, and the effects of percutaneous coronary intervention (PCI) among women are worse than in men. AIM: To compare direct results of PCI in men and women. METHODS: The study was a retrospective assessment of case records of one thousand consecutive patients treated with PCI because of acute myocardial infarction (AMI) (344 patients), unstable angina (UA) (164 patients) and stable angina (SA) (492 patients). We examined the effects of demographic, angiographic and clinical variables on the duration of hospitalisation and in-hospital mortality separately in men and in women. RESULTS: Women constituted 30.7% of patients treated with PCI because of AMI, 39.6% of those with UA and just 25.8% of those with SA. Women were significantly older than men, had a higher BMI, and more often suffered from hypertension and diabetes. The duration of hospitalisation was the same in men and women if the reason for PCI was SA or UA, however, in case of AMI women were hospitalised significantly longer than men. In the univariate analysis gender had no influence on in-hospital mortality regardless of the reason for PCI treatment. Among the variables subjected to multivariate analysis female gender, age, BMI, diabetes, hypercholesterolaemia, indication for PCI, final TIMI flow in the target vessel and cardiogenic shock as a complication of AMI were shown to affect mortality. Significant effects on in-hospital mortality for women were exhibited only by cardiogenic shock. Among men, indication for PCI, age, diabetes and final TIMI flow in the target vessel also had a significant influence on in-hospital mortality. CONCLUSIONS: Stable angina is a reason for performing PCI more rarely in women than in men. Women with CAD are older than men and have more risk factors. The in-hospital mortality among patients treated with PCI because of SA is independent of gender. Cardiogenic shock appeared to be the only factor that influences in-hospital mortality in women. In the case of men such an influence is also observed for indication for PCI (AMI, UA or SA), diabetes and final TIMI flow in the target vessel.     

Prevalence of ischaemic heart disease in middle aged British men.

The prevalence of ischaemic heart disease was determined by an administered questionnaire and electrocardiography in 7735 men aged 40-59 years drawn at random from general practices in 24 British towns. Overall, one quarter of these men had some evidence of ischaemic heart disease on questionnaire or electrocardiogram or both. On questionnaire, 14% of men had possible myocardial infarction or angina, with considerable overlap of the two syndromes. The prevalence of possible myocardial infarction combined with angina and of definite angina only showed a fourfold increase over the age range studied. Electrocardiographic evidence of ischaemic heart disease (definite or possible) was present in 15% of men, there being myocardial infarction in 4.2% and myocardial ischaemia in 10.3%. Electrocardiographic evidence of myocardial infarction increased fourfold over the age range studied. There was considerable overlap of questionnaire and electrocardiographic evidence of ischaemic heart disease. Nevertheless, more than half of those with possible myocardial infarction combined with angina had no resting electrocardiographic evidence of ischaemic heart disease, and half of those with definite myocardial infarction on electrocardiogram had no history of chest pain at any time. This national population based study strongly suggests that the prevalence of ischaemic heart disease in middle aged British men is greater than has been indicated by previous studies based on occupational groups.     

Prevalence of ischaemic heart disease in middle aged British men

The prevalence of ischaemic heart disease was determined by an administered questionnaire and electrocardiography in 7735 men aged 40-59 years drawn at random from general practices in 24 British towns. Overall, one quarter of these men had some evidence of ischaemic heart disease on questionnaire or electrocardiogram or both. On questionnaire, 14% of men had possible myocardial infarction or angina, with considerable overlap of the two syndromes. The prevalence of possible myocardial infarction combined with angina and of definite angina only showed a fourfold increase over the age range studied. Electrocardiographic evidence of ischaemic heart disease (definite or possible) was present in 15% of men, there being myocardial infarction in 4.2% and myocardial ischaemia in 10.3%. Electrocardiographic evidence of myocardial infarction increased fourfold over the age range studied. There was considerable overlap of questionnaire and electrocardiographic evidence of ischaemic heart disease. Nevertheless, more than half of those with possible myocardial infarction combined with angina had no resting electrocardiographic evidence of ischaemic heart disease, and half of those with definite myocardial infarction on electrocardiogram had no history of chest pain at any time. This national population based study strongly suggests that the prevalence of ischaemic heart disease in middle aged British men is greater than has been indicated by previous studies based on occupational groups.     

Prevalence of ischemic heart disease and mortality among kaunas population aged 35-64 years in the prospective study

MONICA (MONItoring trends and determinants of CArdiovascular diseases) study was carried out in Kaunas in 1983-1993 in three random samples of population aged 35-64 (overall 2694 men and 2801 women). The prevalence of previous MI among men was higher than among women in the first and in the third surveys (2,2 and 1,1%, p <0,05 and 4,4 and 1,2%, p <0,001, respectively). The prevalence of angina pectoris among men and among women did not reveal statistically significant difference in all three surveys. The prevalence of silent myocardial ischemia was higher among women than among men in the two surveys. The prevalence of all forms of IHD was higher among women than among men in the first and in the second surveys (16,2 and 10,2%, p <0,001 and 16,4 and 10,9%, p <0,001, respectively). Total mortality, mortality from CVD and from IHD among men with IHD was higher than among men without IHD. Total mortality and mortality from CVD among women with silent myocardial ischemia and IHD was higher than in control group. The differences in mortality among women with different forms of IHD were not significant from those without IHD.     

The natural history of prevalent ischaemic heart disease in middle-aged men.

OBJECTIVE: To describe the long-term outcome of different forms of symptomatic and asymptomatic ischaemic heart disease in middle-aged men. METHODS: 7735 men aged 40-59, randomly selected from 24 general practices in Britain were classified into one of seven ischaemic heart disease groups according to a questionnaire and electrocardiogram (ECG): I=diagnosed myocardial infarction; II=unrecognized myocardial infarction; III= diagnosed angina; IV=angina symptoms; V=possible myocardial infarction symptoms; VI=ECG ischaemia or possible myocardial infarction; VII=no evidence of ischaemic heart disease. The association of disease group with a range of fatal and non-fatal outcomes during 15 years of follow-up was assessed. RESULTS: At baseline 25% of men had evidence of ischaemic heart disease (groups I-VI). Risks of major ischaemic heart disease events, total and cardiovascular mortality, stroke, and major cardiovascular events tended to increase strongly from group VII to I. Diagnosed myocardial infarction was associated with a much poorer prognosis than all other groups (including unrecognized infarction) for all cardiovascular outcomes other than stroke. The relative risk associated with ischaemic heart disease at baseline declined dramatically over time. However, men with myocardial infarction who survived event-free for 10 years continued to experience a high excess risk in the subsequent 5 years, in contrast to event-free survivors of angina and other ischaemic heart disease. Adjusted to an average age of 50, the percentage of men surviving for 15 years free of a new major cardiovascular event was 44 for diagnosed myocardial infarction, 52 for unrecognized myocardial infarction, 66 for diagnosed angina, 68 for angina symptoms, 73 for possible myocardial infarction symptoms, 73 for ECG ischaemia, and 79 for no ischaemic heart disease. Comparison of outcome between prevalent and incident myocardial infarction illustrated the improved prognosis of men surviving the initial years after their event. CONCLUSIONS: Differing manifestations of prevalent ischaemic heart disease are associated with widely differing outcome, and the majority of middle-aged men in the community who have evidence of ischaemic heart disease short of myocardial infarction survive for 15 years without heart attack or stroke. The excess risk associated with myocardial infarction appears more persistent than that associated with angina and other ischaemic heart disease, remaining high even after 10 years of event-free survival.