Design - A multicentre unblinded randomised clinical trial.

Setting - 38 hospitals in six countries.

Subjects - 1036 patients who had been treated with anistreplase for myocardial infarction were randomly assigned to either aspirin (150 mg daily) or anticoagulation (intravenous heparin followed by warfarin or other oral anticoagulant). The trial was stopped earlier than originally intended because of the slowing rate of recruitment.

Main outcome measure - Cardiac death or recurrent myocardial infarction at 30 days.

Results - After 30 days cardiac death or reinfarction, occurred in 11.0% (57/517) of the patients treated with anticoagulation and 11.2% (58/519) of the patients treated with aspirin (odds ratio 1.02, 95% confidence interval 0.69 to 1.50, P=0.92). Corresponding findings at three months were 13.2% (68/517) and 12.1% (63/519) (0.91, 0.63 to 1.32, P=0.67). Patients receiving anticoagulation were more likely than patients receiving aspirin to have had severe bleeding or a stroke by three months (3.9% v 1.7% (0.44, 0.20 to 0.97, P=0.04)).

Conclusion - No evidence of a difference in the incidence of cardiac events was found between the two treatment groups, though the trial is too small to claim treatment equivalence confidently. A higher incidence of severe bleeding events and strokes was detected in the group receiving anticoagulation, suggesting that aspirin may be the drug of choice for most patients in this context.

Flat 1,
7 Netherhall Gardens,
London NW3 5RN

D G Julian, emeritus professor of cardiology,

University of Newcastle upon Tyne
Royal Sussex County Hospital,
Brighton BN2 5BE

D A Chamberlain, honorary consultant cardiologist

London School of Hygiene and Tropical Medicine,
London WC1E 7HT

S J Pocock, professor of medical statistics

Correspondence to: Professor Julian.

Design - Register linkage study. Information on suicides in women of reproductive age was linked with the Finnish birth, abortion, and hospital discharge registers to find out how many women who committed suicide had had a completed pregnancy during her last year of life.

Setting - Nationwide data from Finland.

Subjects - Women who committed suicide in 1987-94.

Results - There were 73 suicides associated with pregnancy, representing 5.4% of all suicides in women in this age group. The mean annual suicide rate was 11.3 per 100 000. The suicide rate associated with birth was significantly lower (5.9) and the rates associated with miscarriage (18.1) and induced abortion (34.7) were significantly higher than in the population. The risk associated with birth was higher among teenagers and that associated with abortion was increased in all age groups. Women who had committed a suicide tended to come from lower social classes and were more likely to be unmarried than other women who had had a completed pregnancy.

Conclusions - The increased risk of suicide after an induced abortion indicates either common risk factors for both or harmful effects of induced abortion on mental health.

Unit of Statistics,
Registers and Information Systems,
National Research and Development Centre for Welfare and Health (STAKES),
PO Box 220,
00531 Helsinki,
Finland
Mika Gissler, researcher

Health Service Research Unit,
National Research and Development Centre for Welfare and Health (STAKES)

Elina Hemminki, research professor

National Public Health Institute,
Department of Mental Health,
Mannerheimintie 160,
00300 Helsinki

Jouko Lonnqvist, research professor

Correspondence to: Mr Gissler.

Design - Cross sectional analysis of status of cardiovascular risk factors and past and present social circumstances.

Subjects - 5645 male participants in the west of Scotland collaborative study, a workplace screening study.

Main outcome measures - Strength of association between each risk factor for cardiovascular disease (diastolic blood pressure, serum cholesterol concentration, level of recreational physical exercise, cigarette smoking, body mass index, and FEV 1 score (forced expiratory volume in one second as percentage of expected value) and social class during childhood (based on father's main occupation) and adulthood (based on own occupation at time of screening).

Results - All the measured risk factors were significantly associated with both father's and own social class (P\h0.05), apart from exercise and smoking (not significantly associated with father's social class) and body mass index (not significantly associated with own social class). For all risk factors except body mass index, the regression coefficient of own social class was larger than the regression coefficient of father's social class.

The difference between the coefficients was significant for serum cholesterol concentration, cigarette smoking, body mass index, and FEV 1 score (all P<0.001).

Conclusions - Subjects' status for behavioural risk factors (exercise and smoking) was associated primarily with current socioeconomic circumstances, while status for physiological risk factors (serum cholesterol, blood pressure, body mass index, and FEV 1) was associated to varying extents with both past and present socioeconomic circumstances.

Academic Department of Psychiatry,
Charing Cross and Westminster Medical School,
London W6 8RP

D Blane, senior lecturer in medical sociology

Department of Public Health,
University of Glasgow,
Glasgow G12 8RZ

C L Hart, research assistant

Department of Social Medicine,
University of Bristol,
Bristol BS8 2PR

G Davey Smith, professor of clinical epidemiology

West of Scotland Cancer Surveillance Unit,
Ruchill Hospital,
Glasgow G20 9NB

C R Gillis, director
D J Hole, principal epidemiologist

Department of Epidemiology,
University of Michigan,
Michigan 48109

V M Hawthorne, emeritus professor

Correspondence to: Dr Blane.

Design - Cohort study.

Setting - 11 practices in Edinburgh, Scotland.

Subjects - 1592 men and women aged 55-74 years selected at random from the age-sex registers of 11 general practices and followed up for 5 years.

Main outcome measures - Incidence of fatal and non-fatal cardiovascular events and all cause mortality.

Results - At baseline 90 (5.7%) of subjects had an ankle brachial pressure index less than or equal to 0.7, 288 (18.2%) had an index less than or equal to 0.9, and 566 (35.6%) less than or equal to 1.0. After five years subjects with an index less than or equal to 0.9 at baseline had an increased risk of non-fatal myocardial infarction (relative risk 1.38, 95% confidence interval 0.88 to 2.16), stroke (1.98, 1.05 to 3.77), cardiovascular death (1.85, 1.15 to 2.97), and all cause mortality (1.58, 1.14 to 2.18) after adjustment for age, sex, coronary disease, and diabetes at baseline. The ability to predict subsequent events was greatly increased by combining the index with other risk factors-for example, hypertensive smokers with normal cholesterol concentrations had a positive predictive value of 25.0%, increasing to 43.8% in subjects with a low index and decreasing to 15.6% in those with a normal index.

Conclusion - The ankle brachial pressure index is a good predictor of subsequent cardiovascular events, and improves on predictions by conventional risk factors alone. It is simple and accurate and could be included in routine screening of cardiovascular status.

Wolfson Unit for Prevention of Peripheral Vascular Diseases,
Department of Public Health Sciences,
University of Edinburgh,
Edinburgh EH8 9AG

G C Leng, clinical research fellow
F G R Fowkes, professor of epidemiology
A J Lee, research statistician
J Dunbar, research sister

Royal Infirmary of Edinburgh NHS Trust,
Edinburgh EH3 9YW

E Houstey, consultant physician
C V Ruckley, professor of vascular surgery

Correspondence to: Professor Fowkes.