After adjusting for traditional risk factors such as age, gender, systolic blood pressure, urine protein, prior myocardial infarction, and medication use including β-blocker, angiotensin converting enzyme inhibitors, and angiotensin II receptor blockers, individuals with lower circulating PON lactonase activity and PON adjusted lactonase activity still had worse survival outcomes at 10 years (hazard ratio 1.48, 95% CI 1.02 to 2.14, p < 0.05 for PON lactonase activity and hazard ratio 1.55, 95% CI 1.07 to 2.25, p < 0.05 for PON-1 protein adjusted lactonase activity; Table 2). Here, ACE is linked to myocardial infarction.