Abstract
BackgroundThe primary objective of this study is to estimate the association between body mass index (BMI) and the risk of first acute myocardial infarction (AMI). As a secondary objective, we considered the association between other lifestyle variables, smoking and heavy alcohol use, and AMI risk.MethodsThis study was conducted in the general practice research database (GPRD) which is a database based on general practitioner records and is a representative sample of the United Kingdom population. We matched cases of first AMI as identified by diagnostic codes with up to 10 controls between January 1st, 2001 and December 31st, 2005 using incidence density sampling. We used multiple imputation to account for missing data.ResultsWe identified 19,353 cases of first AMI which were matched on index date, GPRD practice and age to 192,821 controls. There was a modest amount of missing data in the database, and the patients with missing data had different risks than those with recorded values. We adjusted our analysis for each lifestyle variable jointly and also for age, sex, and number of hospitalizations in the past year. Although a record of underweight (BMI <18.0 kg/m2) did not alter the risk for AMI (adjusted odds ratio (OR): 1.00; 95% confidence interval (CI): 0.87–1.11) when compared with normal BMI (18.0–24.9 kg/m2), obesity (BMI ≥30 kg/m2) predicted an increased risk (adjusted OR: 1.41; 95% CI: 1.35–1.47). A history of smoking also predicted an increased risk of AMI (adjusted OR: 1.81; 95% CI: 1.75–1.87) as did heavy alcohol use (adjusted OR: 1.15; 95% CI: 1.06–1.26).ConclusionThis study illustrates that obesity, smoking and heavy alcohol use, as recorded during routine care by a general practitioner, are important predictors of an increased risk of a first AMI. In contrast, low BMI does not increase the risk of a first AMI.
Highlights
The primary objective of this study is to estimate the association between body mass index (BMI) and the risk of first acute myocardial infarction (AMI)
We considered the association between other lifestyle variables, smoking and heavy alcohol use, and AMI risk
We identified all first-ever AMIs recorded in the general practice research database (GPRD) between January 1st, 2001 and December 31st, 2005 using the medical codes recorded in the database as our cases
Summary
The primary objective of this study is to estimate the association between body mass index (BMI) and the risk of first acute myocardial infarction (AMI). Clinical databases based on general practice records are a potentially useful source of information (when it is available) for studying the magnitude of risk factors such as obesity, smoking and heavy alcohol use at the population level in a real-world setting. These databases often have missing data on some patients which needs to be properly accounted for in any analysis. We sought to determine if the choice of how to deal with missing information was important
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