Atherosclerotic Risk Genotypes and Recurrent Coronary Events After Myocardial Infarction
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- 作者：Arthur J. Moss ; Daniel Ryan ; David Oakes ; Robert E. Goldstein ; Henry Greenberg ; Monty M. Bodenheimer ; Mary W. Brown ; Robert B. Case ; Edward M. Dwyer ; Jr. et al.
- 刊名：The American Journal of Cardiology
- 出版年：2005
- 出版时间：2005
- 年：2005
- 卷：96
- 期：2
- 页码：177-182
- 全文大小：90 K
文摘
The association of a group of prespecified atherosclerotic risk genotypes with recurrent coronary events (coronary-related death, nonfatal myocardial infarction, or unstable angina) was investigated in a cohort of 1,008 patients after infarction during an average follow-up of 28 months. We used a carrier-ship approach with time-dependent survivorship analysis to evaluate the average risk of each carried genotype. Contrary to expectation, the hazard ratio for recurrent coronary events per carried versus noncarried genotype was 0.89 (95 % confidence interval 0.80 to 0.99, p = 0.03) after adjustment for relevant genetic, clinical, and environmental covariates. This hazard ratio, derived from the 7 prespecified genotypes, indicated an average 11 % reduction in the risk of recurrent coronary events per carried versus noncarried genotype. At 1 year after hospital discharge, the cumulative probability of recurrent coronary events was 26 % in those who carried ≤1, 20 % for those with 2 to 4, and 13 % for those with ≥5 of these genotypes (p = 0.02). This unexpected risk reversal is a likely consequence of changes in the mix of risk factors in pre- and postinfarction populations. In conclusion, this under appreciated, population-based, risk-reversal phenomenon may explain the inconsistent associations of genetic risk factors with outcome events in previous reports involving coronary populations with different risk attributes.