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XV. Prognosis of Coronary Heart Disease Found at Entry

T HE PRESENT study was not designed to focus on the prognosis of established disease although, in a sense, prognosis was and is a major concern in these investigations. The International Cooperative Study was organized primarily to seek answers to questions about the portent for future coronary heart disease of the characteristics and mode of life of middle-aged men in contrasting population samples. Attention has been concentrated on the subsequent experience of men judged to be free of CHD at the entry examination. However, the entry examinations produced 241 men who were not free of CHD, and their experience in the following five years merits some attention. Most published reports on the prognosis of CHD concern patients who were subjected to one or another process of selection-they were cared for in a particular hospital, sought help from a particular physician, were members of a specific insured group, and so on. And those reports commonly concern the prognosis starting with the clinical onset, an acute episode of angina pectoris or myocardial infarction. The present material differs in that the subjects were not found because they were seeking help because of illness or suspicion of disease; they were simply caught in the net that took in practically all men of the age in the geographical area or, in the case of the railroad men, in the occupation. Some of the men knew they had CHD, but our follow-up of them did not start from a clinical episode; many of the men found to have CHD had not been so diagnosed previously, but again, their follow-up did not date from any particular clinical stage in the disease. Accordingly, the findings in regard to prognosis in this study are not necessarily comparable to those in other reports. In considering the five-year outcomes summarized below, attention should be paid to