This epidemiologic study explored the sex differential in risk of death from coronary heart disease in persons with or without clinically diagnosed diabetes or asymptomatic hyperglycemia. Use was made of 9-year follow-up data from the Chicago Heart Association Detection Project in Industry for 11,220 white men and 8,030 white women aged 35-64 years at entry to the Project (November 1967-January 1973). Both clinically diagnosed diabetes and asymptomatic hyperglycemia were associated with an increased risk of death from coronary heart disease. The extent of this association was greater in women than in men in regard to relative risk. However, absolute excess risk for both diabetics and those with asymptomatic hyperglycemia was larger for men than for women. Clinical diabetes appeared to be an independent risk factor for coronary heart disease in both men and women based on multivariate Cox regression analyses. On the other hand, for men, no significant independent effect of asymptomatic hyperglycemia was apparent. Women with asymptomatic hyperglycemia had significantly higher coronary heart disease death rates than normoglycemic women, with adjustment for major coronary heart disease risk factors; in multivariate analyses, the relationship of asymptomatic hyperglycemia to risk of coronary heart disease was of borderline significance (p = 0.054). This study indicates the independent associations of diabetes and possibly asymptomatic hyperglycemia with coronary heart disease mortality, with greater relative significance in women than in men.

SUMMARY The relationship of education to risk factors at baseline and to long-term mortality from coronary heart disease (CHD), cardiovascular diseases (CVD), and all causes was analyzed for three cohorts of middle-aged employed white men in Chicago: 8047 from the Chicago Heart Association Detection Project in Industry (CHA) (entry 1967-1973), 1250 from the Peoples Gas Company Study (PG) (entry 1958-1959) and 1730 from the Western Electric Study (WE) (entry 1957-1958). Each man was classified into one of four groups: not a high school graduate, high school graduate, some college but not a graduate, or college graduate. For all three cohorts, a graded, inverse association was observed at baseline between education and blood pressure, which was statistically significant for CHA and WE men and independent of age and relative weight. For all three cohorts, a significant, graded, inverse association was also recorded between education and cigarette use at entry. For serum cholesterol, no clear pattern was observed for the education groups in any of the three cohorts. CHA men showed a graded, inverse relationship between education and relative weight. This cohort was the only one of three showing a significant, graded inverse association between education and prevalence of ECG abnormalities at entry. For this CHA cohort, 5-year follow-up data showed a statistically significant, graded, inverse relationship between education and ageadjusted mortality rates from CHD, CVD and all causes. With adjustment for entry age, diastolic pressure, cigarettes, serum cholesterol, relative weight and ECG abnormalities, this inverse relationship remainedreduced in degree, but still statistically significant for CVD mortality. Similarly, for the pooled PG-WE cohort of 2980 with 20-21 years of follow-up, education and the three mortality end points were inversely related but not graded, with statistical significance for all three end points in the univariate analyses. The results of these studies indicate inverse relationships between education and lifestyle-related risk factors at baseline and between education and long-term risk of CHD, CVD and all-causes mortality. The inverse relationship between education and mortality is accounted for in part by the established major biomedical risk factors. SOCIAL CONDITIONS are widely believed to be important in influencing the development of coronary heart disease (CHD). Several investigations have reported an association between education and risk of CHD. However, whether education is related to CHD over and above the well-established major coronary risk factors is unclear. [1][2][3][4][5][6][7] Data from three epidemiologic studies in industry in Chicago provided an opportunity to examine this question. In this report we assessed whether educational level is associated with risk of death from CHD, all

The independent contributions of ST segment depression and/or T wave abnormality (ST-T abnormalities) on the baseline resting electrocardiogram to risk of 11.5 year coronary heart disease (CHD) mortality were explored among 9203 white men and 7818 white women who were 40 to 64 years old and without definite CHD at entry in the Chicago Heart Association Detection Project in Industry. At baseline, prevalence rates of ST-T abnormalities were age related for both sexes, and at every age the rate was higher in women than men (age-adjusted prevalence rates 12.3% and 8.1%, respectively). Univariate analysis showed that ST-T abnormalities were associated with significantly increased risk of death from CHD for both men and women. However, men with ST-T abnormalities had much greater age-adjusted and multiple risk factor-adjusted absolute excess risk and relative risk than women with such electrocardiographic abnormalities. When baseline age, diastolic pressure, serum cholesterol, cigarettes/day, history of diabetes, and baseline use of antihypertensive medication were included in the multivariate analysis, ST-T abnormalities remained significantly related to death from CHD in men but not women. The interaction term between sex and ST-T abnormalities was at a borderline level of statistical significance by Cox regression analysis. In conclusion, ST-T abnormalities indicate an increased risk of subsequent death from CHD independent of major coronary risk factors for middle-aged U.S. men, but this is not clearly so for women. Circulation 75, No. 2, 347-352, 1987. ST SEGMENT DEPRESSION and/or T wave abnormalities on the resting electrocardiogram are among the most common findings encountered in clinical examination of patients, in screening asymptomatic adults, and in epidemiologic surveys. The association of ST-T abnormalities with increased coronary heart disease (CHD) mortality was reported in insurance experience over 30 years ago.`2 Subsequently, the

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SUMMARY The importance of major and minor ECG abnormalities at baseline for subsequent risk of death from coronary heart disease, cardiovascular diseases and all causes was analyzed for middle-aged white men from the Chicago Peoples Gas Company, Chicago Western Electric Company and Chicago Heart Association Detection Project in Industry studies. Univariate analysis showed that in all three studies, men with major ECG abnormalities had death rates considerably higher than those with normal ECGs. When baseline age, diastolic pressure, serum cholesterol, relative weight and number of cigarettes per day were taken into consideration in multivariate analysis, ECG abnormalities retained significant relationship to the three death end points. Findings from the Chicago Western Electric Company and Chicago Heart Association studies showed independent relationship between minor ECG abnormalities and the three death end points. In the Chicago Peoples Gas Company (20-year follow-up) and in the Chicago Western Electric Company (17-year follow-up), when the deaths were divided into those that occurred within the first 10 years of follow-up and those that occurred more than 10 years after entry, the association between ECG abnormalities and mortality held for both the first and second decades of follow-up. Overall, findings from this study demonstrate an independent relationship between ECG abnormalities and death from coronary heart disease, cardiovascular disease and all causes.