Myocardial infarction: increase in triglycerides or total cholesterol increase the risk of recurrent MI.

Clinical bottom line (level 3b)

  1. 6% of male physicaian's who had a myocardial infarction had another one within 12 months.
  2. Male physicians who have had a myocardial infarction were at increased risk of having another one if they: had higher triglycerides, or higher total cholesterol.
Stampfer et al: Journal of the American Medical Association 1996; 276 (11): 882-888
Expires March 2003

The study

Case-control study with objective outcomes, adjusted for confounding factors, not validated in an independent set of patients.

Setting: population-based among male physicians, USA

574 patients (aged range 40 to 84 years; mean 59, 100% male) male physicians

Excluded if
  • history of myocardial infarction, stroke, transient ischaemic attack, cancer (except nonmelanoma skin cancer), current renal or liver disease, peptic ulcer or gout, contraindication to aspirin or current use of aspirin, other platelet active agents or vitamin A supplements


Cases: 266 patients (100% male, mean age 59): nonfatal myocardial infarction
Controls: 308 patients (100% male, mean age 59): free from myocardial infarction

Factors studied:
  • future myocardial infarction


Factors summarised:

Multivariate analysis was used to adjust for confounding factors.

Outcomes studied:

The evidence

  • Risk of MI with total cholesterol, per 1.03 mmol/L (40 mg/dL) increase
    • RR 1.80 (95% CI 1.44 to 2.26)
    • NNF 21 (95% CI 13 to 38)
  • Risk of MI with rising triglycerides, per1.13 mmol/L (100 mg/dL) increase
    • RR 1.40 (95% CI 1.10 to 1.77)
    • NNF 42 (95% CI 22 to 167)

Comments

  1. Data was taken from the Physicians' Health Study comparing aspirin with beta carotene.

Citation

  1. Stampfer MJ, Krauss RM, Ma J, et al: A prospective study of triglyceride level, low-density lipoprotein particle diammeter, and risk of myocardial infarction. Journal of the American Medical Association 1996; 276 (11): 882-888
Contributor: Clare Wotton and Bob Phillips, January 2000
Reviewer:

Clinical Question.
    Patient no previous myocardial infarction etc
    Intervention or Exposure presence of small, dense LDL particles and raised triglyceride levels
    Comparison absence of risk factors
    Outcome myocardial infarction