Atherosclerotic risk genotypes and recurrent coronary events after myocardial infarction

Arthur J. Moss*, Daniel Ryan, David Oakes, Robert E. Goldstein, Henry Greenberg, Monty M. Bodenheimer, Mary W. Brown, Robert B. Case, Edward M. Dwyer, Shirley W. Eberly, Charles W. Francis, John A. Gillespie, Ronald J. Krone, Edgar Lichstein, Jean W. MacCluer, Frank I. Marcus, Jeanette McCarthy, Charles E. Sparks, Wojciech Zareba

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

13 Scopus citations


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.

Original languageEnglish
Pages (from-to)177-182
Number of pages6
JournalThe American Journal of Cardiology
Issue number2
StatePublished - 15 Jul 2005
Externally publishedYes


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