Læknablaðið - 15.08.1996, Page 47

LÆKNABLAÐIÐ 1996; 82
593
of those with unrecognised and recognised
myocardial infarction was largely the same.
One-third of men with unrecognised and 58%
of men with recognised myocardial infarction
had a history of angina pectoris. Angina
pectoris had a greater effect on coronary heart
disease mortality in the former group. Silent
ST-T changes among men without overt coron-
ary heart disease were found to be a marker of
latent coronary heart disease and hypertens-
ion. These silent ST-T changes were associated
with increased mortality. Cardiomegaly was
detected in 6.5% of the men in the cohort. It
was associated with hypertension in 51% and
coronary heart disease in one-third of the ca-
ses. The presence of coronary heart disease
had marked deleterious effect on the prognosis
of those with cardiomegaly and serum cholest-
erol concentration, systolic blood pressure and
smoking more than 15 cigarettes/day had sign-
ificant independent effect on survival.
The prevalence of coronary heart disease in
Icelandic men is decreasing. The prognosis is
determined by a complex interplay between
the form of coronary heart disease and the risk
factor profile. Unrecognised myocardial in-
farction accounts for at least 30% of all
myocardial infarction and when associated
with angina, the prognosis is severe. Silent
ST-T changes among men without known cor-
onary heart disease indicate both coronary
heart disease and hypertension and signify
impaired prognosis. Cardiovascular risk
factors maintain their detrimental effects am-
ong men with cardiomegaly, indicating that in
face of cardiomegaly complacency is not justi-
fied in the control of the major risk factors of
coronary heart disease.