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Does high intelligence improve prognosis? The association of intelligence with recurrence and mortality among Swedish men with coronary heart disease
  1. Alma Sörberg Wallin1,
  2. Daniel Falkstedt2,3,
  3. Peter Allebeck2,
  4. Bo Melin3,
  5. Imre Janszky2,4,
  6. Tomas Hemmingsson1,5
  1. 1Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
  2. 2Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
  3. 3Division of Psychology, Department of Clinical Neurosciences, Karolinska Institutet, Stockholm, Sweden
  4. 4Department of Public Health and General Practice, NTNU, Trondheim, Norway
  5. 5Centre for Social Research on Alcohol and Drugs, Stockholm University, Stockholm, Sweden
  1. Correspondence to Alma Sörberg Wallin, Institute of Environmental Medicine, Karolinska Institutet, Solnavägen 4, Stockholm 113 65, Sweden; alma.sorberg{at}


Background Lower intelligence early in life is associated with increased risks for coronary heart disease (CHD) and mortality. Intelligence level might affect compliance to treatment but its prognostic importance in patients with CHD is unknown.

Methods A cohort of 1923 Swedish men with a measure of intelligence from mandatory military conscription in 1969–1970 at age 18–20, who were diagnosed with CHD 1991–2007, were followed to the end of 2008. Primary outcome: recurrent CHD event. Secondary outcome: case fatality from the first event, cardiovascular and all-cause mortality. National registers provided information on CHD events, comorbidity, mortality and socioeconomic factors.

Results The fully adjusted HRs for recurrent CHD for medium and low intelligence, compared with high intelligence, were 0.98, (95% CIs 0.83 to 1.16) and 1.09 (0.89 to 1.34), respectively. The risks were increased for cardiovascular and all-cause mortality with lower intelligence, but were attenuated in the fully adjusted models (fully adjusted HRs for cardiovascular mortality 1.92 (0.94 to 3.94) and 1.98 (0.89 to 4.37), respectively; for all-cause mortality 1.63 (1.00 to 2.65) and 1.62 (0.94 to 2.78), respectively). There was no increased risk for case-fatality at the first event (fully adjusted ORs 1.06 (0.73 to 1.55) and 0.97 (0.62 to 1.50), respectively).

Conclusions Although we found lower intelligence to be associated with increased mortality in middle-aged men with CHD, there was no evidence for its possible effect on recurrence in CHD.

  • Social and life-course epidemiology

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