First-ever Acute Myocardial Infarction Research Articles

Clinical characteristics of delirium in older patients with first-ever acute myocardial infarction who underwent percutaneous coronary intervention : Aretrospective study.

Delirium is aserious complication of cardiac surgery and acommon clinical problem. The study aimed to identify the incidence, risk factors, and outcomes of delirium in older patients (≥ 65years) with first-ever acute myocardial infarction (AMI) who underwent percutaneous coronary intervention (PCI). Aretrospective cohort study was performed in ahospital in northern China. Atotal of 1033 older patients with first-ever AMI who underwent PCI between January 2018 and April 2021 were screened for delirium using the CAM-ICU method. Clinical and laboratory data were collected. Atotal of 134 (12.97%) patients were diagnosed with delirium. Patients with delirium were older. The most common concomitant diseases were cardiac arrest, chronic renal failure, and ahistory of coronary artery bypass graft (CABG). Delirious patients experienced more times of mechanical ventilation, more intra-aortic balloon pump (IABP) support, high postoperative immediate pain score (VAS), more non-bedside cardiac rehabilitation, and longer total length of stay and cardiac care unit (CCU) time. Multivariable logistic regression showed that age, mechanical ventilation, postoperative immediate pain score, and non-bedside cardiac rehabilitation were independently associated with delirium. Delirium was an independent predictor of prolonged CCU stay, total length of stay, and 1‑year mortality. Age, mechanical ventilation, postoperative immediate pain score, and non-bedside cardiac rehabilitation were independently closely related to delirium in older patients with first-ever AMI who underwent PCI. Delirium was associated with ahigher 1‑year all-cause mortality.

A Mass Spectrometry-Based Proteome Study of Twin Pairs Discordant for Incident Acute Myocardial Infarction within Three Years after Blood Sampling Suggests Novel Biomarkers.

Acute myocardial infarction (AMI) is a major cause of mortality and morbidity worldwide, yet biomarkers for AMI in the short- or medium-term are lacking. We apply the discordant twin pair design, reducing genetic and environmental confounding, by linking nationwide registry data on AMI diagnoses to a survey of 12,349 twins, thereby identifying 39 twin pairs (48-79 years) discordant for their first-ever AMI within three years after blood sampling. Mass spectrometry of blood plasma identified 715 proteins. Among 363 proteins with a call rate > 50%, imputation and stratified Cox regression analysis revealed seven significant proteins (FDR < 0.05): FGD6, MCAM, and PIK3CB reflected an increased level in AMI twins relative to their non-AMI co-twins (HR > 1), while LBP, IGHV3-15, C1RL, and APOC4 reflected a decreased level in AMI twins relative to their non-AMI co-twins (HR < 1). Additional 50 proteins were nominally significant (p < 0.05), and bioinformatics analyses of all 57 proteins revealed biology within hemostasis, coagulation cascades, the immune system, and the extracellular matrix. A protein-protein-interaction network revealed Fibronectin 1 as a central hub. Finally, technical validation confirmed MCAM, LBP, C1RL, and APOC3. We put forward novel biomarkers for incident AMI, a part of the proteome field where markers are surprisingly rare and where additional studies are highly needed.

Association between admission blood glucose and prognosis in non-diabetic patients with first-ever acute myocardial infarction

Background: Admission hyperglycemia has been associated with major adverse cardiovascular and cerebrovascular events (MACCEs) in patients with acute coronary syndrome.Methods: In this study we sought to determine the association between admission blood sugar (ABS) and the outcomes of non-diabetic patients with first-ever acute myocardial infarction (MI). Non-diabetic patients with MI were evaluated from March 2016 to March 2019. Baseline characteristics, laboratories, electrocardiogram, and baseline left ventricular ejection fraction (LVEF) were recorded. All patients were followed up and outcomes were obtained. Follow-up data comprised of repeating electrocardiogram and echocardiography at 1 year, and MACCE, including re-MI, stroke, and mortality.Results: A total of 312 patients with a mean age of 54.2 ± 11.9 years were evaluated. All patients were followed up for a median of 38 months. The frequencies of in-hospital mortality and MACCE at late follow-up were higher in third tertile of ABS compared with those in first and second tertiles (both p <0.05). Based on the Cox regression analysis, the independent predictors of MACCE included age (hazard ratio [HR] 1.068, 95% confidence interval [CI] 1.033 - 1.105, p <0.001), third tertile of ABS >172 mg/dL (HR 21.257, 95% CI 2.832 - 159.577, p=0.003), and baseline LVEF (HR 0.947, 95% CI 0.901 - 0.995, p=0.031).Conclusion: Admission stress hyperglycemia is associated with increased rates of in-hospital mortality and MACCE at late follow-up in non-diabetic patients with MI. Moreover, elevated ABS, older ages, and a decreased value of baseline LVEF predicted MACCE during follow-up.

Cross-classified Multilevel Analysis of Individual Heterogeneity and Discriminatory Accuracy (MAIHDA) to evaluate hospital performance: the case of hospital differences in patient survival after acute myocardial infarction

ObjectiveTo describe a novel strategy, Multilevel Analysis of Individual Heterogeneity and Discriminatory Accuracy (MAIHDA) to evaluate hospital performance, by analysing differences in 30-day mortality after a first-ever acute myocardial infarction...

Risk of a first-ever acute myocardial infarction and all-cause mortality with sulphonylurea treatment: A population-based cohort study.

We investigated the association between the current use of individual sulphonylureas and the risk of a first‐ever acute myocardial infarction (AMI) and all‐cause mortality, in a population‐based cohort study, using primary care data from the Clinical Practice Research Datalink database (2004‐2012). New users (N = 121 869), aged ≥18 years, with at least one prescription for a non‐insulin antidiabetic agent were included. The first prescription defined start of follow‐up. Time‐dependent Cox proportional hazard models were used to estimate the risk of a first‐ever AMI and all‐cause mortality associated with the use of individual sulphonylureas, and other non‐insulin glucose‐lowering drugs. No differences in risk of a first‐ever AMI (adjusted hazard ratio [HR] 1.02, 95% confidence interval [CI] 0.70‐1.50) or all‐cause mortality (adjusted HR 0.97, 95% CI 0.80‐1.17) were observed when comparing gliclazide use with non‐gliclazide sulphonylurea use. Similar results were found for each individual sulphonylurea. As evidence is accumulating that gliclazide is no safer than other sulphonylureas, current guidelines suggesting superiority should be carefully evaluated.

Trends in the incidences of acute myocardial infarction in coastal and inland areas in Japan: The Yamagata AMI Registry

BackgroundIt has been reported that there are regional differences in the incidence of acute myocardial infarction (AMI) in Japan. The purpose of this study was to investigate trends in regional differences in AMI incidence and dyslipidemia between coastal and inland areas. MethodsWe investigated trends in AMI incidence and risk factors in 5325 first-ever AMI patients residing in a coastal area (n=1817), a rural inland area (n=1959), or an urban inland area (n=1549) for the periods 1994–2002, and 2003–2010, using data from the Yamagata AMI Registry. ResultsPatients in the coastal area were significantly older than those in rural and urban inland areas and had a lower prevalence of dyslipidemia. The age-adjusted incidence rate of AMI was significantly lower in coastal and rural inland areas patients than those from urban inland area (males: 43.3, 42.2, and 51.3/105 person-years; females: 17.4, 20.0, and 23.7/105 person-years, respectively) during 2 observation periods. Due to a large increase in AMI incidence in younger males of the coastal area and a decrease in AMI incidence in late elderly females of the urban inland area, no significant regional differences in the age-adjusted incidence rates of AMI were observed during the 2003–2010 period in both genders. The increase in AMI incidence in males in the coastal area was associated with an increasing prevalence of dyslipidemia. ConclusionThere were no longer any regional differences observed in AMI incidence, which was considered to be associated with increased dyslipidemia especially in the coastal area.

Acute case-fatality rates of stroke and acute myocardial infarction in a Japanese population: Takashima stroke and AMI registry, 1989-2005.

Few comprehensive stroke and acute myocardial infarction registries of long duration exist in Japan to illustrate trends in acute case-fatality of stroke and acute myocardial infarction with greater precision. We examined 17-year case-fatality rates of stroke and acute myocardial infarction using an entire community-monitoring registration system to investigate trends in these rates over time in a Japanese population. Data were obtained from the Takashima Stroke and AMI Registry covering a stable population of approximately 55 000 residents of Takashima County in central Japan. We divided the total observation period of 17 years into four periods, 1989-1992, 1993-1996, 1997-2000, and 2001-2005. We calculated gender, age-specific and age-adjusted acute case-fatality rates (%) of stroke and acute myocardial infarction across these four periods. During the study period of 1989-2005, there were 341 fatal cases within 28 days of onset among 2239 first-ever stroke events and 163 fatal cases among 433 first-ever acute myocardial infarction events. The age-adjusted acute case-fatality rate of stroke was 14·9% in men and 15·7% in women. The age-adjusted acute case-fatality rate of acute myocardial infarction was 34·3% in men and 43·3% in women. The age-adjusted acute case-fatality rates of stroke and acute myocardial infarction showed insignificant differences across the four time periods. The average annual change in the acute case-fatality rate of stroke (-0·2%; 95% CI: -2·4-2·1) and acute myocardial infarction (2·7%; 95% CI: -0·7-6·1) did not change significantly across the study years. The acute case-fatality rates of stroke and acute myocardial infarction have remained stable from 1989 to 2005 in a rural and semi-urban Japanese population.

Primary preventive potential of major lifestyle risk factors for acute myocardial infarction in men: an analysis of the EPIC-Heidelberg cohort

The aim of this study was to assess the preventive potential of major lifestyle risk factors for acute myocardial infarction (AMI) in middle-aged men. Among 10,981 men in the Heidelberg cohort of the European Prospective Investigation into Cancer and Nutrition, aged 40.2-65.8 years when recruited, 378 developed first-ever AMI during a median follow-up period of 11.4 years. Current smoking, excess body weight, being physically inactive, but not high alcohol consumption, were identified as the major lifestyle risk factors for AMI using Cox regression analysis. A competing AMI risk model built from cause-specific Cox regression models and considering the risk of death predicted 353 AMI cases, 182 (51.6%) of which were estimated as preventable through adherence to a healthy lifestyle profile (never smoking, normal body weight, physically active, and moderate alcohol consumption). The calculated age-specific 5-year incidence rates for AMI in the actual cohort and in a hypothetical, comparable cohort with all men following the healthy lifestyle profile were 128 and 39, respectively, per 100,000 person-years for the age group 40-44, increasing to 468 and 307 per 100,000 person-years for the age group 65-69. The estimated AMI incidence rates for men with the healthy lifestyle profile are still somewhat higher than the average rates reported for documented low-incidence regions, such as parts of Japan. Our analysis confirms the strong primary preventive potential for AMI based on avoidance of smoking and excess body weight, and on regular physical activity.

Short-Term Exposure to Air Pollution and Incidence of Stroke and Acute Myocardial Infarction in a Japanese Population

Background: Exposure to high levels of air pollution can increase the risk of cardiovascular events. However, there is no clear information in Japan on the effect of pollution on the incidence of stroke and acute myocardial infarction (AMI). Therefore, we investigated the effects of air pollution on the incidence of stroke and AMI in a setting where pollutant levels are rather low. Methods: Data were obtained from the Takashima Stroke and AMI Registry, which covers a population of approximately 55,000 in Takashima County in central Japan. We applied a time-stratified, bidirectional, case-crossover design to estimate the effects of air pollutants, which included suspended particulate matter (SPM), sulfur dioxide (SO₂), nitrogen dioxide (NO₂) and photochemical oxidants (Ox). We used the distributed lag model to estimate the effect of pollutant exposure 0-3 days before the day of event onset and controlled for meteorological covariates in all of the models. Results: There were 2,038 first-ever strokes (1,083 men, 955 women) and 429 first-ever AMI cases (281 men, 148 women) during 1988-2004. The mean pollutant levels were as follows: SPM 26.9 µg/m³; SO₂ 3.9 ppb; NO₂ 16.0 ppb, and Ox 28.4 ppb. In single-pollutant and two-pollutant models, SO₂ was associated with the risk of cerebral hemorrhage. Other stroke subtypes and AMI were not associated with air pollutant levels. Conclusions: We observed an association between SO₂ and hemorrhagic stroke; however, we found inconclusive evidence for a short-term effect of air pollution on the incidence of other stroke types and AMI.

Mortality After Acute Myocardial Infarction: Significance of Cardiovascular Diabetic Autonomic Neuropathy (CDAN)

The aim of this study was to compare intrahospital and long-term mortalities after more than 10 years of the follow up after the first acute myocardial infarction (AMI) with patients with and without CDAN and without diabetes mellitus (DM). The study was based on 76 (43 men and 33 women) with DM type 2, CDAN was detected in 51 patients, and 374 (295 men and 79 women) without DM consecutively hospitalized with the first-ever AMI from January 1998. to December 2000. in Clinical Center of Montenegro Podgorica. Patients were followed until December 31. 2011. CDAN was searched for by standardized five tests evaluating heart rate and blood pressure variations. Intrahospital mortality was presented in 10.53% diabetic patients and 5.61% nondiabetic patients, this difference is significant (p = 0.048). Long-term mortality was presented at 24 (82.75%) patients with CDAN and 5 (17.25%) patients without CDAN (p = 0.029). Long-term mortality rate was significantly higher in diabetic patients 29 (42.64%) than in nondiabetic patients 102 (30.72%) (p = 0.012). Intrahospital mortality was significantly higher in diabetic than in nondiabetic patients. Identically the mortality after more than 10 years of the follow up after the first AMI was significantly higher in diabetic with, than in diabetic patients without CDAN, as in diabetic than in nondiabetic patients.

Diurnal incidence of acute myocardial infarction in a Japanese population (From the Takashima AMI Registry, 1988–2004)

Summary Background We examined the circadian periodicity of acute myocardial infarction (AMI) onset to identify any existing specific pattern using 17-year AMI registration data. Methods Data were obtained from the Takashima AMI Registry, which covered a stable population of approximately 55,000 in Takashima County in central Japan. Out of 429 registered first-ever AMI events from 1988–2004, there were 352 events with classifiable onset time. AMI onset was categorized as occurring at night (midnight to 6a.m.), morning (6a.m. to noon), afternoon (noon to 6p.m.) or evening (6p.m. to midnight). Results There was a significant diurnal variation in AMI incidence ( P Conclusion A diurnal pattern of AMI onset was observed in a Japanese population with a morning peak and nighttime trough, and the pattern was similar across seasons of the year and days of the week.

Sex Differences in Patient-Reported Symptoms Associated With Myocardial Infarction (from the Population-Based MONICA/KORA Myocardial Infarction Registry)

Many studies have examined gender-related differences in symptoms of acute myocardial infarction (AMI). However, findings have been inconsistent, largely because of different study populations and different methods of symptom assessment and data analysis. This study was based on 568 women and 1,710 men 25 to 74 years old hospitalized with a first-ever AMI from January 2001 through December 2006 recruited from a population-based AMI registry. Occurrence of 13 AMI symptoms was recorded using standardized patient interview. After controlling for age, migration status, body mass index, smoking, some co-morbidities including diabetes, and type and location of AMI through logistic regression modeling, women were significantly more likely to complain of pain in the left shoulder/arm/hand (odds ratio [OR] 1.36, 95% confidence interval [CI] 1.10 to 1.69), pain in the throat/jaw (OR 1.78, 95% CI 1.43 to 2.21), pain in the upper abdomen (OR 1.39, 95% CI 1.02 to 1.91), pain between the shoulder blades (OR 2.22, 95% CI 1.78 to 2.77), vomiting (OR 2.23, 95% CI 1.67 to 2.97), nausea (OR 1.94, 95% CI 1.56 to 2.39), dyspnea (OR 1.45, 95% CI 1.17 to 1.78), fear of death (OR 2.17, 95% CI 1.73 to 2.72), and dizziness (OR 1.49, 95% CI 1.16 to 1.91) than men. Furthermore, women were more likely to report >4 symptoms (OR 2.14, 95% CI 1.72 to 2.66). No significant gender differences were found in chest pain, feelings of pressure or tightness, diaphoresis, pain in the right shoulder/arm/hand, and syncope. In conclusion, women and men did not differ regarding the chief AMI symptoms of chest pain or feelings of tightness or pressure and diaphoresis. However, women were more likely to have additional symptoms.

Gender-Specific Short and Long-Term Mortality in Diabetic Versus Nondiabetic Patients With Incident Acute Myocardial Infarction in the Reperfusion Era (the MONICA/KORA Myocardial Infarction Registry)

The aim of this study was to investigate gender-specific short- and long-term mortalities after a first acute myocardial infarction (AMI) in patients with and without diabetes mellitus (DM). The study was based on 505 men and 196 women with DM and 1,327 men and 415 women without DM consecutively hospitalized with a first-ever AMI from January 1998 to December 2003 recruited from a population-based MI registry. Patients were followed until December 31, 2005 (median follow-up time 4.3 years). In men and women, no significantly independent association between DM and short-term mortality was observed. After multivariable adjustment odds ratios (95% confidence intervals [CIs]) for 28-day case fatality were 1.45 (95% CI 0.90 to 2.34) in men with DM compared to men without DM and 1.44 (95% CI 0.66 to 3.15) in women with DM compared to women without DM. Conversely, in 28-day AMI survivors DM was significantly associated with long-term mortality in age-adjusted analyses, in which men with DM had a hazard ratio (HR) of 1.57 (95% CI 1.18 to 2.10) for all-cause mortality compared to non-DM men; the corresponding HR in women with DM was 2.91 (95% CI 1.82 to 4.65). After multivariable adjustment the strong association in women with DM remained significant (HR 2.56, 95% CI 1.53 to 4.27); however, in men with DM it became borderline significant (HR 1.36, 95% CI 1.00 to 1.85). In conclusion, short-term mortality was not significantly increased in men and women with DM after a first-ever AMI, although estimates were relatively high, indicating a possible relation. However, long-term mortality was higher in patients with AMI and DM, particularly in women.

Broadening Our Understanding of Survival After Myocardial Infarction

As clinicians and scientists, it is common to presume that clinical outcomes after myocardial infarction (MI) are most profoundly influenced by the pathogenesis of the disease itself, including genetics, cardiovascular risk factors, inflammatory state, disease severity (eg, the number and severity of obstructed coronary arteries), and the treatments that we offer. Consequently, our efforts to optimize the outcomes of our patients are aimed at following clinical guidelines in care for individual patients.1–3 When our profession seeks to influence systems of care and public policy, our focus has been on increasing access to lifesaving therapies.4 Because they appear outside of physicians’ locus of control, risk factors related to patients’ socioeconomic status are often not considered targets for intervention. Article see p 375 Although numerous studies have defined an adverse association between lower socioeconomic status and post-MI treatment5 and outcomes,6–8 little work has been done to develop interventions to overcome these disparities. We also have not sought to systematically understand mediating factors that may influence the prognostic associations of socioeconomic risk factors with outcomes. The reasons there have been such little progress in overcoming socioeconomic status barriers, despite the national priorities to create equity in health care,9–11 are multifactorial and include both the difficulties in measuring socioeconomic status and the challenges in overcoming them. In a critical review of the science linking socioeconomic status to health outcomes, Braveman and colleagues12 demonstrated that different measures of socioeconomic status are not interchangeable, …

Trends in Coronary Risk Factors Among Patients with Acute Myocardial Infarction Over the Last Decade: The Yamagata AMI Registry

Recently, there has been an increase in the prevalence of coronary risk factors, such as diabetes and dyslipidemia, in Japan; however, it is unclear whether this has resulted in an increased incidence of acute myocardial infarction (AMI). We investigated the relationship between risk factors changes and AMI incidence in a Japanese population. Trends in AMI incidence (per 100,000 person-years) were examined using data from the Yamagata AMI Registry from 1993 to 2007. We included 6,222 patients with a first-ever AMI (4175 men). The prevalence of coronary risk factors was investigated in three age groups of AMI patients (<65, 65-74, and ≥75 years) for the periods 1993-1997, 1998-2002, and 2003-2007. Coronary risk factors were further compared between recently registered AMI patients and 2,400 age-matched controls. The age-adjusted incidence of AMI increased significantly in men, but not in women. Younger men particularly showed a significant increase in the incidence of AMI. The prevalence of hypertension and diabetes increased in both genders; however, the prevalence of treatment for risk factors was significantly lower in men than women. Younger men showed significant increases in obesity and hypertriglyceridemia. Consequently, risk factors associated with the metabolic syndrome had accumulated among younger men. We revealed that hypertension, diabetes, hypercholesterolemia and current smoking were independent risk factors for AMI. The incidence rate for AMI increased significantly in men, especially younger men. Preventive care for risk factors associated with metabolic syndrome, in addition to conventional risk factors, may be required in younger men.

Trend of Increase in the Incidence of Acute Myocardial Infarction in a Japanese Population: Takashima AMI Registry, 1990-2001

The incidence and mortality of acute myocardial infarction (AMI) remain low in Japan despite major dietary changes and worsening cardiovascular risk factors, a situation that should have resulted in a substantial increase in AMI rates (Japanese paradox). The current trend in the incidence of AMI was examined for the period 1990-2001 by use of data from the Takashima AMI Registry covering a stable population of approximately 55,000 in central Japan. AMI incidence rates (per 100,000 person-years) and 95% confidence intervals were calculated for 1990-1992, 1993-1995, 1996-1998, and 1999-2001. The incidence trend was determined by calculating the average annual change in percentage across the years. There were 352 (men: n = 224; women: n = 128) registered first-ever AMI cases during 1990-2001. The age-adjusted incidence rate of all AMI showed a gradual increase from 39.9 (95% confidence interval (CI): 29.8, 50.0) in 1990-1992 to 62.6 (95% CI: 51.5, 73.7) in 1999-2001. In men, the age-adjusted incidence rate increased from 66.5 (95% CI: 46.4, 86.6) in 1990-1992 to 100.7 (95% CI: 78.6, 122.7) in 1999-2001. In women, fluctuation was observed after an initial steep increase. The average annual incidence increased by 7.6% (95% CI: 3.5, 11.7) among men and by 8.3% (95% CI: 1.02, 15.6) among women. To the best of the authors' knowledge, this is the first study to report an increasing trend of AMI in a Japanese population.

Temporal trends in the frequency and longer‐term outcome of heart failure complicating myocardial infarction

To investigate trends in incidence and long-term outcome of heart failure (HF) developing within 28 days of first-ever acute myocardial infarction (AMI). We identified all residents of Perth, Western Australia aged 25-64 years, with no history of HF, who experienced a non-fatal, first-ever AMI between 1984 and 1993, and followed them for ten years. All patients (N=4006) met the criteria for 'definite AMI' in WHO MONItoring trends and determinants of CArdiovascular disease (MONICA) Project and 897 (22.4%) had early-onset HF complicating the index event. After adjustment for age, current smoking, history of diabetes and hypertension, Q-wave and anterior wall AMI, the odds of developing HF declined by 9% (odds ratio for period 1989-1993 relative to 1984-1988=0.91, 95% confidence interval (95%CI): 0.78 to 1.06). Over 10 years of follow-up, patients with early-onset HF had a cumulative average number of re-admissions of 28 per 100 as compared with 9 per 100 in patients without HF. After adjustment for age, history of diabetes and hypertension, the hazard of death in patients with early-onset HF declined by 26% (HR for the period 1989-1993 relative to 1984-1988=0.74, 95%CI: 0.57 to 0.96). Our data suggest a decline in the incidence of, and show encouraging evidence of improvement in survival after, early-onset HF complicating AMI.

Estimated intake of milk fat is negatively associated with cardiovascular risk factors and does not increase the risk of a first acute myocardial infarction. A prospective case-control study.

Milk fat is high in saturated fatty acids (SFA) and high intakes of SFA are associated with cardiovascular diseases. The aim of the present study was to prospectively evaluate the potential risk of a first-ever acute myocardial infarction (AMI) in relation to the estimated milk-fat intake, reflected as the proportions of pentadecanoic acid (15 : 0) and heptadecanoic acid (17 : 0) in serum lipid esters. This was evaluated in a study population selected within the Västerbotten Intervention Program and the northern Sweden 'Monitoring of Trends and Determinants in Cardiovascular disease' survey populations. A prospective case-control design was used. The proportions of the biomarkers were lower in the cases (n 78) than in the controls (n 156), who were matched for age, sex, sampling time and geographical region. The standardised odds ratios of becoming an AMI case were between 0.7 and 0.8 for the biomarkers. The proportions of 15 : 0 and 17 : 0 in serum phospholipids were significantly and negatively correlated to serum concentrations of plasminogen activator inhibitor-1, tissue-type plasminogen activator, triacylglycerols, insulin, specific insulin, pro-insulin and leptin (all P<0.0001), suggesting a negative relationship to the insulin-resistance syndrome and the risk of CHD. Adjustment for BMI did not materially change the relationships. Although there seems to be a negative association between milk-fat intake as mirrored by the proportions of 15 : 0 and 17 : 0 in serum lipid esters and a first-ever AMI, adjustment for clinical risk factors removed this relationship.

Leptin is associated with increased risk of myocardial infarction.

Leptin is involved in the regulation of bodyweight and metabolism in man and might also be involved in the pathophysiology of the insulin resistance syndrome, which is associated with the development of cardiovascular diseases. We tested whether leptin is a risk factor for acute myocardial infarction (AMI) in a nested case-referent study. Sixty-two men with first-ever AMI were identified who, prior to AMI, had participated in population-based health surveys in Northern Sweden. Referents were matched for sex, age, date and type of health survey, and geographical region. Blood pressure, body mass index (BMI) and the presence of smoking, diabetes and hypertension were recorded. Total cholesterol, apolipoprotein A-1 (apo A-1), apolipoprotein B (apo B), plasminogen activator inhibitor (PAI-1), insulin, and leptin were analysed in stored samples. Their influences on first-ever AMI were analysed by conditional logistic regression analysis. Men with first-ever AMI had higher BMI, plasma insulin and leptin, and diastolic blood pressure than the referents. Furthermore, they had lower plasma apo A-1 and were more often smokers. Smoking, high leptin, PAI-1 and cholesterol, and low apo A-1 levels were significant risk factors for first-ever AMI in univariate analysis. High leptin (OR 8.97; 95% CI: 1.73-46.5) and cholesterol (OR 5.18; 95% CI: 1.34-20.0) levels remained significant risk factors for AMI in a multivariate model. High apo A-1 was protective (OR = 0.13; 95% CI: 0.03-0.55). The combination of high leptin and low apo A-1 was associated with a particularly pronounced increased risk for AMI. Plasma leptin strongly predicts first-ever AMI. Our data support the hypothesis that leptin is an important link in the development of cardiovascular disease in obesity.

Do simple prudent health behaviours protect men from myocardial infarction?

We tested whether behaviours such as discarding obvious fat on meat, cessation of smoking, avoidance of passive smoking, habitual use of reduced fat milk, prudent consumption of alcohol and regular but moderate physical exercise are associated with a reduction of cardiovascular risk. This was a population-based case-control study done in Perth, Western Australia. The cases (n = 336) were men aged 27-64 years with a first-ever acute myocardial infarction (AMI) during the period 1992-1993, and who survived at least 28 days. The controls (n = 735) were participants in a population-based survey of cardiovascular risk factors conducted during May-November 1994. Both groups completed the same questionnaire and the data were analysed with multiple logistic regression using backward elimination technique. Among men aged 27-64 years simple measures such as participation in nonvigorous exercise (odds ratio [OR] = 0.5, 95% CI: 0.4-0.7), and avoidance of added salt (OR = 0.6, 95% CI: 0.4-0.9) are associated with significant and important protection from AMI. After 25 years of falling mortality in Australia, lifestyles can still be significantly improved to reduce heart disease even further.