Natural history of coronary heart disease and heart disease of uncertain etiology: Findings from a 50-year population study

ObjectivesTo describe the natural history of common heart disease incidence on a population study.Material and methodsA sample of 1712 men aged 40–59 was enrolled in 1960 and followed-up for 50 years. Coronary heart disease (CHD) was categorized if manifested as sudden death, fatal and non-fatal myocardial infarction and other acute coronary syndromes, and as Heart Disease of Uncertain Etiology (HDUE) if manifested as heart failure, chronic arrhythmia, blocks, diagnoses of chronic CHD or hypertensive heart disease. Their characteristics and prognosis in terms of age at event, mortality and expectancy of life up to 50 years were analyzed.ResultsIncidence of first CHD and HDUE event or diagnosis was of 26.9 and 20.6%, respectively. First events were equally manifested as fatal or non-fatal occurrences among CHD, while non-fatal occurrences were almost always observed among HDUE. Cases of HDUE presented at a more advanced age and also average age at death was significantly more advanced than in CHD, respectively around 79 and 76 years. Expectancy of life was significantly longer for HDUE (30.7 years) than for CHD (27.6 years). Strokes were more frequently ascertained among HDUE (14%) while 14% of death causes were due to cancer in both CHD and HDUE. Cancers were much higher (40%) among those never diagnosed CHD or HDUE who also had more stroke-due deaths (17%).ConclusionThis is the first investigation to report heart disease incidence and its natural history in a quasi-extinction cohort data from Italy in a pre-cardiac surgery era.