PROCAM milestones
During the past 30 years, the PROCAM Study has led to important results regarding the risk of coronary heart disease and stroke:
1979 | Start of the PROCAM Study |
1980 | First description of rationale and study design [1] |
1982 | First report on the relationship of HDL-apolipoprotein A-I and HDL-Cholesterol on risk factors of coronary heart disease [2] |
1983 | First report on the role of the apolipoprotein E polymorphism in coronary artery disease [3] |
1984 | First report on lipoprotein (a) on coronary risk [4] |
1985 | First report on baseline data of age, gender, body-weight, smoking, alcohol consumption and pill-using [5] |
| Relation between fibrinogen and blood pressure, blood glucose, uric acid, and plasma lipids published [6] |
1986 | Association of the apolipoprotein E polymorphism with LDL cholesterol and coronary artery disease reported [7] |
1987 | Major report issued on the prognostic significance of hyperlipidemia with systemic hypertension in men [8] |
1988 | Extensive analysis on the relationship between haemostatic variables and the presence and the extent of coronary atherosclerosis published [9] |
| First European Consensus conference on primary prevention of coronary heart disease issues treatment recommendations based largely on PROCAM study results [10] |
| Prevalence of hyperlipidemia in persons with hypertension and/or diabetes mellitus and the relationship to coronary heart disease revealed [11] |
1989 | Impact of diabetes mellitus and hypertension on coronary risk published [12] |
| European Atherosclerosis Society issues therapeutic recommendations largely basing on PROCAM study results [13] |
1990 | Further evidence for HDL cholesterol as independent risk factor provided [14] |
| Identification of Lipoprotein(a) as independent risk factor for myocardial infarction at a young age [15] |
| Refined PROCAM risk algorithm published [16] |
| First summary on research on role of genes published [17] |
1991 | Relationship of lipoprotein(a) to variables of coagulation and fibrolysis reported. [18] |
1992 | Relation of HDL cholesterol and triglycerides to the incidence of atherosclerotic coronary artery disease discovered [19] |
| Major reports on the role of triglycerides and HDL cholesterol for CHD risk published [20-22] |
1994 | Report on the role of fibrinogen and factor VII in the prediction of coronary risk [23] |
| Prevalence of risk factors for coronary heart disease in the former German Democratic Republic (Dresden) and Western Germany (PROCAM) described [24] |
1995 | Introduction of the concept of high global risk for myocardial infarction [25] |
| Role of naturally occurring apolipoprotein A-I variants for HDL-cholesterol levels described [26] |
| Role of Fibrinogen in cardiovascular risk reviewed [27] |
| Report issued on the role of mutations in the factor V and apolipoprotein A-I genes for the risk of myocardial infarction [28] |
| Major report on the role of high triglycerides and elevated lipoprotein(a) levels on the risk for myocardial infarction published [29] |
1996 | Role of elevated LDL-cholesterol for polycystic ovary syndrome revealed [30] |
1997 | Summary on new and classical risk factors for myocardial infarction published [31] |
| Major report issued on the role of smoking as risk factor for coronary artery disease [32] |
| Report on the role of plasma homcysteine levels on coronary risk [33] |
1998 | Results of follow-up at 8 years published [34] |
| Definition of the „lipid triad“ as important predictor for the risk of myocardial infarction [34] |
| First report on the risk of stroke [35] |
1999 | Role of overweight and obesity in mortality and cardiovascular disease published [36] |
| Important review on prevention of coronary heart disease published [37] |
2000 | Risk factors for diabetes mellitus defined [38] |
2001 | Important review on the role of HDL, triglycerides and other lipid subfractions in the future of lipid management [39] |
| Specific role of Lipoprotein(a) for the risk of coronary events in men with high global cardiovascular risk discovered [40] |
2002 | Simple scoring scheme for calculating the risk of myocardial infarction published [41] |
| CHD risk prediction by means of neural networks introduced [42] |
2003 | Major report issued comparing PROCAM risk functions with risk functions derived from Framingham and MONICA [43] |
| Important review on HDL cholesterol published [44] |
2004 | Report published summarizing the relationship between metabolic syndrome and cardiovascular risk [45] |
2005 | Report on importance of arterial pulse pressure as a predictor of coronary heart disease risk in PROCAM published. [46] |
| Plasma sitosterol elevations are associated with an increased incidence of coronary events in men, Results of a nested study in PROCAM published [47] |
| Report on the relationship between phytosterol levels and components of the metabolic syndrome in the PROCAM study published [48] |
| Important review “Implications of emerging risk factors for therapeutic intervention” published [49] |
2006 | Important report on genes on chromosome 17 which confer susceptibility to coronary artery disease published [50] |
| Type 2 diabetes and risk of coronary heart disease - results of the 10-year follow-up of the PROCAM study published [51] |
| Report published comparing the definition of metabolic syndrome of the Adult Treatment Panel III and the International Diabetes Federation in U.S. American and European populations [52] |
2007 | PROCAM algorithms accurately predict coronary risk in patients with metabolic syndrome [53] |
Implementation of an improved score system for assessment of cardiovascular risk in elderly men and women based on Weibull model [54,55] | |
| Report published on a scoring scheme for risk assessment of MI and stroke in men and women [55] |
| July: Recruitment of 50.000th participant. |
2009 | Data of PROCAM study contributed to a meta-analysis of the „Emerging Risk Factors Collaboration”, indicating the positive correlation of Lp(a) and incidence not only in CAD but also in stroke [56] |
Data of PROCAM study contributed to a meta-analysis of the „Emerging Risk Factors Collaboration”, clarifying the impact of lipids, lipoproteins and apolipoproteins for vascular risk [57] | |
Data of PROCAM study contributed to a meta-analysis of the „Prospective Studies Collaboration”, indicating that BMI is a strong predictor for mortality. BMI of 30 to 35 kg/m2 shortens the life expectancy by 2 to 4 years, BMI of 40 to 45 kg/m2 by 8 to 10 years. [58] | |
Within a European multicenter study (PROCARDIS) which analyses the influence of genes on premature manifestation of CHD samples of the PROCAM study were used for the control group. Results of the study: 2 variants in Lp(a) genes are closely associated with Lp(a) concentration and the risk for CHD. [59] | |
2010 | Data of PROCAM study contributed to a meta-analysis of the „Emerging Risk Factors Collaboration”, analysing the correlation of diabetes mellitus to risk for coronary heart disease and stroke [60] |
| The risk of myocardial infarction attached to low HDL cholesterol and/or high triglycerides after accounting for other risk factors is substantial, particularly in those with low LDL cholesterol. [61] |
Literature
1. Assmann G, Oberwittler W, Schulte H, Schriewer H, Funke H, Epping PH, Hauss WH. Prädiktion und Früherkennung der koronaren Herzkrankheit. Prospektive epidemiologische Studie bei Betriebsangehörigen im Raum Westfalen. Internist (Berl). 1980;21:446-59.
2. Assmann G, Funke H, Schriewer H. The relationship of HDL-apolipoprotein A-I and HDL-Cholesterol to risk factors of coronary heart disease: initial results of the prospective epidemiological study in company employees in Westfalia. J Clin Chem Clin Biochem. 1982;20:287-9.
3. Menzel HJ, Kladetzky RG, Assmann G. Apolipoprotein E polymorphism and coronary artery disease. Arteriosclerosis. 1983;3:310-5.
4. Schriewer H, Assmann G, Sandkamp M, Schulte H. The relationship of lipoprotein (a) (Lp(a)) to risk factors of coronary heart disease: initial results of the prospective epidemiological study on company employees in Westfalia. J Clin Chem Clin Biochem. 1984;22:591-6.
5. Balleisen L, Bailey J, Epping PH, Schulte H, van de Loo J. Epidemiological study on factor VII, factor VIII and fibrinogen in an industrial population: I. Baseline data on the relation to age, gender, body-weight, smoking, alcohol, pill-using, and menopause. Thromb Haemost. 1985;54:475-9.
6. Balleisen L, Assmann G, Bailey J, Epping PH, Schulte H, van de Loo J. Epidemiological study on factor VII, factor VIII and fibrinogen in an industrial population--II. Baseline data on the relation to blood pressure, blood glucose, uric acid, and lipid fractions. Thromb Haemost. 1985;54:721-3.
7. Lenzen HJ, Assmann G, Buchwalsky R, Schulte H. Association of apolipoprotein E polymorphism, low-density lipoprotein cholesterol, and coronary artery disease. Clin Chem. 1986;32:778-81.
8. Assmann G, Schulte H. The Prospective Cardiovascular Muenster Study: prevalence and prognostic significance of hyperlipidemia in men with systemic hypertension. Am J Cardiol. 1987;59:9G-17G.
9. Schmitz-Huebner U, Thompson SG, Balleisen L, Fechtrup C, Grosse-Heitmeyer W, Kirchhof B, Most E, Muller US, Seiffert C, Seiffert D, van de Loo J. Lack of association between haemostatic variables and the presence or the extent of coronary atherosclerosis. Br Heart J. 1988;59:287-91.
10. Assmann G. European Consensus on Primary Prevention of Coronary Heart Disease. Can J Cardiol. 1988;4:21A-23A. Review.
11. Assmann G, Schulte H. The Prospective Cardiovascular Muenster (PROCAM) study: prevalence of hyperlipidemia in persons with hypertension and/or diabetes mellitus and the relationship to coronary heart disease. Am Heart J. 1988;116:1713-24.
12. Assmann G, Schulte H. Diabetes mellitus and hypertension in the elderly: concomitant hyperlipidemia and coronary heart disease risk. Am J Cardiol. 1989;63:33H-37H.
13. Assmann G, Schulte H. European lipid guidelines: therapeutic recommendations. European Atherosclerosis Society. Am J Cardiol. 1989;63:53H-55H.
14. Assmann G, Funke H. HDL metabolism and atherosclerosis. J Cardiovasc Pharmacol. 1990;16:S15-20. Review.
15. Sandkamp M, Funke H, Schulte H, Köhler E, Assmann G. Lipoprotein(a) is an independent risk factor for myocardial infarction at a young age. Clin Chem. 1990;36:20-3.
16. Assmann G, Schulte H. Modelling the Helsinki Heart Study by means of risk equations obtained from the PROCAM Study and the Framingham Heart Study. Drugs. 1990;40 Suppl 1:13-8.
17. Assmann G. Genes and dyslipoproteinaemias. Eur Heart J. 1990;11:H4-8. Review.
18. Heinrich J, Sandkamp M, Kokott R, Schulte H, Assmann G. Relationship of Lipoprotein(a) to variables of coagulation and fibrolysis in a healthy population. Clin Chem. 1991;37:1950-4.
19. Assmann G, Schulte H. Relation of high-density lipoprotein cholesterol and triglycerides to incidence of atherosclerotic coronary artery disease (the PROCAM experience). Prospective Cardiovascular Muenster study. Am J Cardiol. 1992;70:733-7.
20. Assmann G, Schulte H. The importance of triglycerides: results from the Prospective Cardiovascular Muenster (PROCAM) Study. Eur J Epidemiol. 1992;8 Suppl 1:99-103.
21. Assmann G, Schulte H. Role of triglycerides in coronary artery disease: lessons from the Prospective Cardiovascular Muenster Study. Am J Cardiol. 1992;70:10H-13H.
22. Schulte H, Assmann G. Triglycerides and atherosclerosis: The PROCAM experience. Cardiovasc. Risk Factors 2. 1992; 334-342.
23. Heinrich J, Balleisen L, Schulte H, Assmann G, van de Loo J. Fibrinogen and factor VII in the prediction of coronary risk. Results from the PROCAM study in healthy men. Arterioscler Thromb. 1994;14:54-9. Erratum in: Arterioscler Thromb 1994;14:1392.
24. Jaross W, Assmann G, Bergmann S, Schulte H. Comparison of risk factors for coronary heart disease in Dresden and Muenster. Results of the DRECAN (Dresden Cardiovascular Risk and Nutrition) study and the PROCAM (Prospective Cardiovascular Muenster) Study. Eur J Epidemiol. 1994;10:307-15.
25. Assmann G, Schulte H. Identification of individuals at high risk for myocardial infarction. Atherosclerosis. 1994;110:S11-21.
26. Nofer JR, von Eckardstein A, Wiebusch H, Weng W, Funke H, Schulte H, Köhler E, Assmann G. Screening for naturally occurring apolipoprotein A-I variants: apo A-I(delta K107) is associated with low HDL-cholesterol levels in men but not in women. Hum Genet. 1995;96:177-82.
27. Heinrich J, Assmann G. Fibrinogen and cardiovascular risk. J Cardiovasc Risk. 1995;2:197-205. Review.
28. Heinrich J, Budde T, Assmann G. Mutation in the factor V gene and the risk of myocardial infarction. N Engl J Med. 1995;333:881.
29. Navalesi R, Miccoli R, Odoguardi L, Funke H, von Eckardstein A, Wiebusch H, Assmann G. Genetically determined absence of HDL-cholesterol and coronary atherosclerosis. Lancet. 1995;346:708-9.
30. von Eckardstein S, von Eckardstein A, Bender HG, Schulte H, Assmann G. Elevated low-density lipoprotein-cholesterol in women with polycystic ovary syndrome. Gynecol Endocrinol. 1996;10:311-8.
31. Assmann G, Schulte H, Cullen P. New and classical risk factors--the Muenster heart study (PROCAM). Eur J Med Res. 1997;2:237-42.
32. Cullen P, Schulte H, Assmann G. The Muenster Heart Study (PROCAM): total mortality in middle-aged men is increased at low total and LDL cholesterol concentrations in smokers but not in nonsmokers. Circulation. 1997;96:2128-36.
33. von Eckardstein A, Assmann G. Plasma homocysteine levels and mortality in patients with coronary artery disease. N Engl J Med. 1997;337:1632-3.
34. Assmann G, Cullen P, Schulte H. The Muenster Heart Study (PROCAM). Results of follow-up at 8 years. Eur Heart J. 1998;19:A2-11.
35. Berger K, Schulte H, Stogbauer F, Assmann G. Incidence and risk factors for stroke in an occupational cohort: the PROCAM Study. Prospective Cardiovascular Muenster Study. Stroke. 1998;29:1562-6.
36. Schulte H, Cullen P, Assmann G. Obesity, mortality and cardiovascular disease in the Muenster Heart Study (PROCAM). Atherosclerosis. 1999;144:199-209.
37. Assmann G, Carmena R, Cullen P, Fruchart JC, Jossa F, Lewis B, Mancini M, Paoletti R. Coronary heart disease: reducing the risk: a worldwide view. International Task Force for the Prevention of Coronary Heart Disease. Circulation. 1999;100:1930-8.
38. von Eckardstein A, Schulte H, Assmann G. Risk for diabetes mellitus in middle-aged Caucasian male participants of the PROCAM study: implications for the definition of impaired fasting glucose by the American Diabetes Association. Prospective Cardiovascular Muenster. J Clin Endocrinol Metab. 2000;85:3101-8.
39. Assmann G. Pro and con: high-density lipoprotein, triglycerides, and other lipid subfractions are the future of lipid management. Am J Cardiol. 2001;87:2B-7B. Review.
40. von Eckardstein A, Schulte H, Cullen P, Assmann G. Lipoprotein(a) further increases the risk of coronary events in men with high global cardiovascular risk. J Am Coll Cardiol. 2001;37:434-9.
41. Assmann G, Cullen P, Schulte H. Simple scoring scheme for calculating the risk of acute coronary events based on the 10-year follow-up of the prospective cardiovascular Muenster (PROCAM) study. Circulation. 2002;105:310-5.
42. Voss R, Cullen P, Schulte H, Assmann G. Prediction of risk of coronary events in middle-aged men in the Prospective Cardiovascular Muenster Study (PROCAM) using neural networks. Int J Epidemiol. 2002;31:1253-62; discussion 1262-64.
43. Hense HW, Schulte H, Löwel H, Assmann G, Keil U. Framingham risk function overestimates risk of coronary heart disease in men and women from Germany--results from the MONICA Augsburg and the PROCAM cohorts. Eur Heart J. 2003;10:937-45.
44. Assmann G, Nofer JR. Atheroprotective effects of high-density lipoproteins. Annu Rev Med. 2003;54:321-41. Epub 2001 Dec 3. Review.
45. Assmann G, Nofer JR, Schulte H. Cardiovascular risk assessment in metabolic syndrome: view from PROCAM. Endocrinol Metab Clin North Am. 2004;33:377-92, Review.
46. Assmann G, Cullen P, Evers T, Petzinna D, Schulte H. Importance of arterial pulse pressure as a predictor of coronary heart disease risk in PROCAM. Eur Heart J. 2005;26:2120-6. Epub 2005 Sep 1.
47. Assmann G, Cullen P, Erbey J, Ramey DR, Kannenberg F, Schulte H. Plasma sitosterol elevations are associated with an increased incidence of coronary events in men: Results of a nested case-control analysis of the Prospective Cardiovascular Muenster (PROCAM) study. Nutr Metab Cardiovasc Dis. 2006;16:13-21. Epub 2005 Jul 28.
48. Assmann G, Cullen P, Kannenberg F, Schulte H. Relationship between phytosterol levels and components of the metabolic syndrome in the PROCAM study. Eur J Cardiovasc Prev Rehab. 2007; 14:208-14.
49. Assmann G, Cullen P, Fruchart JC, Greten H, Naruszewicz M, Olsson A, Paoletti R, Riesen W, Stoll M, Tikkanen M, von Eckardstein A for the International Task Force for Prevention of Coronary Heart Disease. Implications of emerging risk factors for therapeutic intervention. Nutr Metab Cardiovasc Dis. 2005;15:373-81.
50. Farrall M, Green FR, Peden JF, Olsson PG, Clarke R, Hellenius ML, Rust S, Lagercrantz J, Franzosi MG, Schulte H, Carey A, Olsson G, Assmann G, Tognoni G, Collins R, Hamsten A, Watkins H. Genome-wide mapping of susceptibility to coronary artery disease identifies a novel replicated locus on chromosome 17. PLoS Genet. 2006;2:e72. Epub 2006 May 19.
51. Buyken AE, von Eckardstein A, Schulte H, Cullen P, Assmann G. Type 2 diabetes and risk of coronary heart disease - results of the 10-year follow-up of the PROCAM study. Eur J Cardiovasc Prev Rehab. 2007;14:230-6.
52. Assmann G, Guerra R, Fox G, Cullen P, Schulte H, Willett DW, Grundy SM. Harmonizing the definition of metabolic syndrome: comparison of the criteria of the Adult Treatment Panel III and the International Diabetes Federation in U.S. American and European populations. Am J Cardiol. 2007;99:541-8. Epub 2007 Jan 2.
53. Assmann G, Schulte H, Seedorf U. Cardiovascular risk assessment in the metabolic syndrome: results from the Prospective Cardiovascular Munster (PROCAM) Study. Int. J. Obes. 2008;32: S11-S16.
54. Assmann G, Schulte H, Seedorf U. The role of genetic predisposition and biomarkers in atherosclerosis. Int. Cong. Ser.1303, 2007;95 – 102.
55. Assmann G, Schulte H, Cullen P, Seedorf U. Assessing risk of myocardial infarction and stroke: new data from the Prospective Cardiovascular Münster (PROCAM) Study. Eur J Clin Invest. 2007;37:925-932.
56. The Emerging Risk Factors Collaboration. Lipoprotein(a) concentration and the risk of coronary heart disease, stroke, and nonvascular mortality. JAMA. 2009;302:412-423.
57. The Emerging Risk Factors Collaboration. Major lipids, apolipoproteins, and risk of vascular disease. JAMA. 2009; 302:1993-2000.
58. The Prospective Studies Collaboration. Body-mass index and cause-specific mortality in 900 000 adults: collaborative analyses of 57 prospective studies. Lancet. 2009;373:1083-1096.
59. PROCARDIS Consortium. Genetic variants associated with Lp(a) lipoprotein level and coronary disease. N Engl J Med. 2009;361:2518-2528.
60. The Emerging Risk Factors Collaboration. Diabetes mellitus, fasting blood glucose concentration, and risk of vascular disease: a collaborative meta-analysis of 102 prospective studies. Lancet. 2010;375:2215-2222.
61. Assmann G, Cullen P, Schulte H. Non-LDL-related dyslipidemia and coronary risk, a case-control study. Diab Vasc Dis Res. Epub 2010 July 19.