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Aetiological studies of myocardial ischaemia have tended to concentrate on factors which influence atherothrombotic processes in the coronary arteries rather than myocardial pathophysiology.1 The commonest clinical measure of heart size—cardiothoracic ratio—was included in the original Whitehall study of healthy middle aged civil servants. Cardiothoracic ratio is associated with left ventricular mass2 and left ventricular systolic function; since left ventricular mass determined by echocardiography has been shown to predict coronary heart disease in elderly people,1 we hypothesised that increased cardiothoracic ratio would independently predict mortality from coronary heart disease. Unlike previous studies3 we did not include mortality from stroke since it may be related to heart size through different pathophysiological mechanisms.View this table:Adjusted hazard ratios (95% confidence intervals) for the effect of cardiothoracic ratio on all cause and coronary heart disease mortalityWe studied the 1203 male British …

Is cardiothoracic ratio in healthy middle aged men an independent predictor of coronary heart disease mortality? Whitehall study 25 year follow up