Coronary disease & ACSCohort study
Risk factors and coronary events: attenuation of the association in secondary prevention
- Retrospective cohort study
- linked electronic health records (CPRD, England)
Authors' conclusion
Risk factor 'weakness' after CHD appears to be a systemic phenomenon and consistent with the operation of index event bias.
Study context
- Population
- Cardiovascular disease (CVD)-free adults and coronary heart disease (CHD) survivors, England
- Participants
- 3,275,736 vs 57,165
- Exposure
- Risk factor associations with first CHD events vs subsequent CHD events
- CVD-freen = 3,275,736reference
- CHD survivorsn = 57,165
- Outcome
- Association of 15 CHD risk factors with first and subsequent CHD events
Main finding
As reported in the abstract
Risk factors retaining a concordant association with subsequent CHD events
9
Observational data: associations, not effects.
Further findings
Subsequent vs first CHD event risk factor associations (15 risk factors)
- Risk factors retaining a concordant association
- 9
- Attenuation of all subsequent CHD event risk factor associations, proportional to first CHD event effect size
- Others showed neutral or paradoxical association with subsequent vs first CHD events
Performance of a 10-year primary prevention risk model
- AUC for first events (performed well)
- .84-.85
- AUC for subsequent events (performed poorly)
- ∼.55
Original publication
Risk factors and coronary events: attenuation of the association in secondary prevention. Eur Heart J. Published 6 August 2026. doi:10.1093/eurheartj/ehag582
Summarised from the published abstract; every number is checked against it