Comparison of risk factors for coronary heart disease morbidity versus mortality.

Abstract

Despite declining rates, coronary heart disease remains a burdensome cause of death and disability worldwide. In on-going efforts to identify new environmental and genetic risk factors for the condition, events based on disease incidence are regarded as being preferable to those based on deaths. Incidence data, which may be derived from record linkage or medical examination in population-based cohort studies, are privileged because of their proximity to risk factor assessment, seemingly providing clearer insights into aetiology. By contrast, mortality data comprise not only the morbid event itself but, in the high probability of survival following a heart attack, prognosis. Owing to the often prohibitively high costs of medical examinations, or an absence of infrastructure for linkage of study members to morbidity registries, most investigators have to rely on death records. In a pooling of data from three large cohort studies whose participants had been linked to death and hospital registries for morbidity, for the first time, we assessed the relative utility of each ascertainment method by relating them to a range of established and emerging risk factors.