Outcomes/Effectiveness Research

Diagnosing coronary heart disease prior to a heart attack improves the chance of lowering the risk of future coronary events

Coronary heart disease (CHD) is the leading killer of men and women in the United States. The time before the first heart attack or other coronary event is potentially the most important period in which primary care doctors can prevent coronary events and death, explains Barbara P. Yawn, M.D., of the Olmsted Medical Center.

Dr. Yawn and colleagues used data from the medical records of all providers in Olmstead County, Minnesota for a random sample of patients with a first heart attack (150 women and 148 men). The researchers reviewed data from the 10 years prior to the first heart attack. They compared the timing of first CHD diagnosis and its relation to recognition and treatment of potentially modifiable CHD risk factors such as smoking, obesity, hypertension, and elevated glucose and lipid levels.

CHD diagnosis and risk factors varied by age and gender. On average, women were older than men at the time of first heart attack (74.7 vs. 65.9 years), and women were more likely to have a diagnosis of CHD prior to the first heart attack. A total of 30.4 percent of men and 52 percent of women received a diagnosis of CHD prior to the heart attack. Women over age 70 and men over age 60 were more likely to have a CHD diagnosis prior to the heart attack than younger women and men.

Women may be more likely to be diagnosed due to more symptomatic CHD, as has been suggested by the higher rate of angina in women than in men prior to heart attack. However, unrecognized and untreated CHD risk factors were present in 45 percent of men and 22 percent of women 5 years prior to the first heart attack. When CHD risk factors were assessed, not all abnormal tests resulted in diagnoses. Furthermore, not all recognized risk factors or diagnosed CHD risk factors were treated in either men or women. For example, 80.8 percent of women and 69.3 percent of men diagnosed with hypertension were receiving antihypertensive therapy. Assessment and treatment rates for hyperlipidemia were even lower.

Earlier CHD diagnosis may provide greater opportunities to address undiagnosed and minimally treated CHD risk factors, perhaps preventing or delaying a cardiac event, note the researchers.

This study was supported by the Agency for Healthcare Research and Quality (HS10239).

See "The gender specific frequency of risk factor and CHD diagnoses prior to incident MI: A community study," by Dr. Yawn, Peter C. Wollan, Ph.D., Roy A. Yawn, M.D., and others, in the April 2007 Family Practice 8(18), available online at http://www.biomedcentral.com.

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