Risk Of Myocardial Infarction In Men Research Articles

Sex hormones and the risk of myocardial infarction in women and men: a prospective cohort study in the UK Biobank

ObjectivesThere is conflicting evidence around the role of sex hormones with cardiovascular outcomes. The aim of this study was to examine the association of sex hormones with the risk of myocardial infarction (MI) in pre- and post-menopausal women, and men in the UK Biobank.MethodsThe UK Biobank is a prospective population-based cohort study, that recruited over 500,000 (aged 40–69 years) women and men between 2006 and 2010.Sex specific cox regression models, estimating hazard ratios (HRs) and women to men ratio of HRs (RHR) with respective 95% confidence intervals (CI), were used to model the association of sex hormones [oestrogen, testosterone, oestrogen: testosterone (O/T) ratio, sex hormone–binding globulin (SHBG) and the free androgen index (FAI)], measured at study baseline, with incident MI for women and men.ResultsData were from 479,797 participants [264,282 (55.1%) women] without a history of MI at study baseline. Over 12.5 years of follow-up, there were 4,908 MI events in women and 10,517 in men. Neither oestrogen nor testosterone were associated with MI in women and men after multiple adjustment. For men, but not women, a unit higher log-transformed O/T ratio was associated with a lower risk of MI 0.79 (0.65, 0.95) after adjustment for traditional CVD risk factors. The corresponding women to men RHR (95% CI) was 1.24 (0.99, 1.56). Higher SHBG (per unit) was also associated with a lower risk of MI in men 0.94 (0.89, 0.99), and not in women 1.02 (0.95, 1.09) after multiple adjustment, the corresponding women to men RHR (95% CI) was 1.09 (1.00, 1.18). Higher FAI was associated with a higher risk of MI in men 1.09 (1.02, 1.15), though not in women 0.97 (0.92, 1.02), the corresponding women to men RHR was 0.89 (0.82, 0.97). Finally, there were differential effects in the association of SHBG and FAI between pre- and post-menopausal women.ConclusionsA higher O/T ratio was associated with a lower risk of MI, and a higher FAI with a higher risk of MI after adjustment for CVD risk factors in men, but not in women. Thus, hormone ratios, rather than each alone, may play an important role in modulating the effect of MI.

АССОЦИАЦИЯ RS429358 И RS7412 ГЕНА АРОЕ С РИСКОМ РАЗВИТИЯ ИНФАРКТА МИОКАРДА

Introduction. Cardiovascular disease (CVD) is the leading cause of death in industrialized countries. The pathology of lipid metabolism, which underlies the atherosclerotic process, is one of the main risk factors for the development of CVD. Genetic markers of predisposition to the development of lipid metabolism disorders can be used for early diagnosis and development of programs for the primary prevention of CVD. Apolipoprotein E is the main apolipoprotein of chylomicrons and is required for the normal catabolism of triglyceride-rich lipoprotein components. The aim of the study was to analyze the association of rs7412 and rs429358 of the APOE gene with the risk of myocardial infarction (MI) in the population of Western Siberia (Russia). Materials and methods: the main group (9360 people, 45-69 years old, mean age 53.8±7) was formed from residents of Novosibirsk, surveyed in 2003-2005. within the framework of the International multicenter project "Risk Factors for Cardiovascular Diseases in Eastern Europe" HAPIEE. The study protocol was approved by the local ethics committee of NIITPM, a branch of the ICG SB RAS. Informed consent was obtained from each study participant for the examination (including the collection of biological materials). For genetic research, 2690 people were selected from the main group by random number method. After excluding unconfirmed MI cases and non-MI deaths, the sample size was 2286 people. The endpoints of the study were MI, stroke, and death from all causes. Data were obtained from the following sources: (i) clinical re-survey of the sample in 2006-2008, 2015; (II) databases: Novosibirsk City Myocardial Infarction Registry, Novosibirsk City Stroke Registry, and Novosibirsk City Mortality Registry (register data are collected at NIITPM, a branch of the Institute of Cytology and Genetics, Siberian Branch of the Russian Academy of Sciences from 1988 to the present). The group with MI consisted of 183 people (128 men, 55 women), inclusion criteria: MI that occurred during the observation period (according to all registries and repeated screenings); MI in history, confirmed by instrumental methods of examination. Exclusion criteria: history of MI, not confirmed by instrumental methods of examination. DNA from blood was isolated by phenol-chloroform extraction. Genotyping of rs429358 and rs7412 of the APOE gene was carried out by the Real-Time PCR method on the StepOnePlus Real-Time PCR System (Thermo Fisher Scientific, Foster City, California, USA). Significance of differences in allele frequencies and verification of compliance with the Hardy-Weinberg equilibrium were calculated using Pearson's χ2 test. Results: The association of rs429358 and rs7412 of the APOE gene with the development of MI in men (p = 0.009) and in the general group (p = 0.001) was revealed. Carrying the ɛ2ɛ4 genotype is associated with an increased risk of MI in men (OR = 3.931, 95% CI: 1.772-8.720, p < 0.0001) and in the general group (OR = 3.753, 95% CI: 1.976-7.127, p < 0 ,0001). Conclusion: our study confirmed a statistically significant association between the genotypes rs7412 and rs429358 and the development of MI both in men and in the general group of the population of Western Siberia (Russia). Structural changes in DNA can independently affect the risk of myocardial infarction. Individuals with confirmed increased genetic risk may receive additional motivation to lead a healthy lifestyle. Data on genetic risk factors for pathology can be used to optimize the clinical management of patients.

Sex-based differences in risk factors for incident myocardial infarction and stroke in the UK Biobank.

This study examined sex-based differences in associations of vascular risk factors with incident cardiovascular events in the UK Biobank. Baseline participant demographic, clinical, laboratory, anthropometric, and imaging characteristics were collected. Multivariable Cox regression was used to estimate independent associations of vascular risk factors with incident myocardial infarction (MI) and ischaemic stroke for men and women. Women-to-men ratios of hazard ratios (RHRs), and related 95% confidence intervals, represent the relative effect-size magnitude by sex. Among the 363313 participants (53.5% women), 8470 experienced MI (29.9% women) and 7705 experienced stroke (40.1% women) over 12.66 [11.93, 13.38] years of prospective follow-up. Men had greater risk factor burden and higher arterial stiffness index at baseline. Women had greater age-related decline in aortic distensibility. Older age [RHR: 1.02 (1.01-1.03)], greater deprivation [RHR: 1.02 (1.00-1.03)], hypertension [RHR: 1.14 (1.02-1.27)], and current smoking [RHR: 1.45 (1.27-1.66)] were associated with a greater excess risk of MI in women than men. Low-density lipoprotein cholesterol was associated with excess MI risk in men [RHR: 0.90 (0.84-0.95)] and apolipoprotein A (ApoA) was less protective for MI in women [RHR: 1.65 (1.01-2.71)]. Older age was associated with excess risk of stroke [RHR: 1.01 (1.00-1.02)] and ApoA was less protective for stroke in women [RHR: 2.55 (1.58-4.14)]. Older age, hypertension, and smoking appeared stronger drivers of cardiovascular disease in women, whereas lipid metrics appeared stronger risk determinants for men. These findings highlight the importance of sex-specific preventive strategies and suggest priority targets for intervention in men and women.

Mild impairment of renal function (shrunken pore syndrome) is associated with increased risk of a future first-ever myocardial infarction in women

Impaired renal function is associated both with the development of cardiovascular disease and its prognosis. A new syndrome called ′Shrunken Pore Syndrome′ has been suggested, as the estimated glomerular filtration rate for cystatin C (eGFRcystatin C) is affected earlier due to differences in molecular size compared to eGFRcreatinine. The aim was to investigate if a lower eGFRcystatin C/eGFRcreatinine ratio in a prospective setting increases the risk of later developing a first-ever myocardial infarction (MI) independently of other cardiovascular risk factors. We used a nested case-referent study design within the Northern Sweden Health and Disease Study, and 545 subjects (29.0% women) were identified who prospectively developed a first-ever MI, and their 1054 matched referents. For women, but not for men, one standard deviation (SD) increase of ln z-scores of eGFRcystatin C/eGFRcreatinine ratio was associated with a lower risk of a future MI: odds ratio [95% confidence interval] 0.58 [0.34–0.99], adjusted for apolipoprotein B/A1 ratio, CRP, homocysteine, systolic blood pressure, body mass index, and diabetes. Furthermore, a high eGFRcreatinine associated independently with an increased risk of future MI in men only: OR 1.25 [1.05–1.48]. Thus, for women, a lower eGFRcystatin C/eGFRcreatinine ratio is associated with a higher risk of having a future first-ever MI, and it may be a valuable, easily implemented biomarker for risk of cardiovascular disease.

Diets Varying in Nutrient Density and Climate Impact and Their Association With Risk of Myocardial Infarction in Northern Sweden

ObjectivesAssess the effects of diets varying in nutrient density and climate impact on risk of myocardial infarction (MI). MethodsDietary data from 39 927 women and 37 390 men 35–65 years in the population-based prospective study Västerbotten Intervention Programme (Sweden) between the years 1990–2016 were used to characterize dietary quality and dietary climate impact. Nutrient density was estimated by the Sweden-adapted Nutrient Rich Foods index NRF11.3, based on 11 nutrients (protein, dietary fiber, iron, folate, vitamins A, C, D, E, magnesium, calcium, potassium) to be encouraged and three nutrients (saturated fat, added sugar, sodium) to be limited. Dietary climate impact was estimated using data from life cycle assessments. Information on MI diagnosis was obtained from registers at the National Board of Health and Welfare in Sweden using personal identification numbers. Hazard ratios (HR) and 95% confidence intervals (CI) were estimated using multivariable Cox proportional hazards regression for four groups of women and men, respectively higher nutrient density, lower climate impact; higher nutrient density, higher climate impact; lower nutrient density, lower climate impact; and lower nutrient density, higher climate impact (reference group). Potential confounders were adjusted for. ResultsMedian follow-up times from recruitment to MI diagnosis for women were 15.8 years and for men 12.8 years, during which time 962 and 2 607 first-time events occurred, respectively. For men a significantly increased risk of MI was found for the group with lower nutrient density and lower climate impact [HR 1.20 (95% CI: 1.06, 1.34); P = 0.003] compared to the group with lower nutrient density and higher climate impact. No significant association was found between the groups of nutrient density and dietary climate impact and MI in women, although a similar trend as that for men was found. ConclusionsA lower compared with a higher dietary climate impact was associated with a higher risk of MI in men when diet quality was below median values, reflecting the importance of considering diet quality when decreasing the climate impact of diets. For women no significant relationship was identified. Funding SourcesThe Swedish Research Council for Environment, Agricultural Sciences and Spatial Planning (Formas).

Linoleic acid in adipose tissue and the risk of myocardial infarction: a case-cohort study.

We investigated risk of myocardial infarction (MI) associated with the content of linoleic acid (LA) in adipose tissue, a biomarker of long-term dietary intake of LA and a marker of endogenous LA exposure. Between 1993 and 1997, 57,053 middle-aged subjects were included in the Danish Diet, Cancer and Health cohort. We performed a case-cohort study that included a random sample of the full cohort (n = 3167) and all incident MI cases appearing during 16years of follow-up (n = 2819). Information on incident MI cases was obtained by linkage with Danish nationwide registries. Adipose tissue biopsies were taken from the buttocks of the participants, and their fatty acid composition was determined using gas chromatography. HRs (hazard ratios) with 95% confidence intervals (CIs) were used to describe the associations between content of LA in adipose tissue and the risk of MI. HRs were calculated using weighted Cox proportional hazards regression with robust variance. After adjustment for established risk factors of MI, adipose tissue content of LA was not associated with the risk of MI in men and women combined (quintiles 5 versus 1, HR, 1.03 (95% CI, 0.85-1.25), P-trend = 0.970) or in men and women separately (quintiles 5 versus 1, HR, 1.05 (95% CI, 0.83-1.33), P-trend = 0.871 and quintiles 5 versus 1, HR, 0.99 (95% CI 0.72-1.37), P-trend = 0.928, respectively). Investigating the association between LA and MI with a shorter, 5- or 10-year duration of follow-up provided similar results. Content of LA in adipose tissue was not associated with the risk of MI.

Cardiovascular health management: preventive assessment

Cardiovascular disease (CVD), the leading cause of death among men and women, represents a significant women's health concern. While the majority of cardiovascular prevention guidelines are similar for men and women, there is growing appreciation that there may be sex differences in the magnitude of relative and absolute benefits and harms of preventive interventions. For instance, while aspirin is associated with a reduction in the risk of CVD events in both men and women, the specific types of benefit appear to differ by sex, with some evidence that aspirin therapy lowers myocardial infarction risk in men (but not women), and ischemic stroke risk in women (but not men). Sex-specific risk assessment may be particularly well established in a primary prevention setting Race, education, waist circumference,waist/hip ratio, typical angina, family history of CAD, high stress, lipids,fasting blood sugar, anemia, insulin, insulin resistance (Homeostasis Model Assessment,HOMA) are particularly important in women together wit peculiar risk facors related to pregnancy, early menopause, autoimmunal diseases and hypoestrogenism. Comparing to men the most predicting CV risk factors appear to be older age, hypertension, history of diabetes, history of smoking, higher triglycerides, and lower Glomerular filtration rate. Regardig Lipoprotein A in the Women's Health Initiative and the Juppiter trial cohorts of women Lp(a) was associated with CVD only among those with high levels of total cholesterol. Further, improvement in risk prediction was minimal in independent validation samples, suggesting that routine screening for Lp(a) may have limited utility in women in primary prevention. The carotid intima-media thickness(cIMT) is widely used to define vascular age. The cIMT tends to be thinner in women than in men, although the evidence to support this finding is controversial . Unfortunately it is only a surrogate marker for atherosclerosis, whereas CT derived coronary calcification as well as, also in our experience, breast artery calcifications, appear to be a valid index of early atheroscerosis. Finally C Reactive Protein appear to be an interesting marker in women in specific situation in our experience.

Sex differences in risk factors for myocardial infarction: cohort study of UK Biobank participants

ObjectivesTo investigate sex differences in risk factors for incident myocardial infarction (MI) and whether they vary with age.DesignProspective population based study.SettingUK Biobank.Participants471 998 participants (56% women; mean age 56.2) with...

Shift work, parental cardiovascular disease and myocardial infarction in males.

Shift work has been associated with an increased risk of cardiovascular disease (CVD). However, there is a need for more studies to determine whether there is an interaction between shift work and other risk factors of CVD, thereby increasing the risk of CVD in shift workers. To discern whether shift work and parental mortality from myocardial infarction (MI) or sudden cardiac death (SCD) interact to increase the risk of MI in men. A case-control dataset was used to assess interaction between shift work and parental history of CVD, using death from MI or SCD, or death before age 65, on an additive scale. Results were reported as relative excess risk due to interaction, attributable proportion due to interaction (AP) and synergy index (SI). There was an interaction between shift work and paternal mortality from MI or SCD, when both factors were present [SI = 2.39; 95% confidence interval (CI) 1.02‒5.6 and AP = 0.4; 95% CI 0.08‒0.73]. Paternal mortality from MI or SCD interacts with shift work to increase the risk of MI in men.

The Emotional, Environmental, Physical and Chemical Triggers of Acute Myocardial Infarction: An Analytical Demographic Study

Objective: Acute triggers are external stimuli that produce acute pathophysiologic changes directly leading to the onset of myocardial infarction (MI). Acute myocardial infarction (AMI) is one of the main causes of mortality. Recent studies have confirmed the impact of acute triggers on the occurrence of AMI, but have not evaluated their differences in terms of demographic characteristics. This study was conducted to investigate the impact of acute triggers on AMI in various demographic groups. Methods: This is an analytical cross-sectional study on 269 patients affected by AMI in two hospitals in 2015 and 2016 in Iran. To attain the goals of the study, acute triggers were divided into four groups of emotional, environmental, physical, and chemical. A researcher-developed questionnaire and interview were used to collect data. The risk and control periods were also evaluated for each trigger. The data were analyzed by descriptive statistics and inferential statistics such as statistical logistic regression and McNemar’s test using SPSS 21. The P-value was set at 0.05. Results: The results showed that sudden exposure to hot/cold weather in men (P=0.03, OR=3.4), underlying diseases (P=0.03, OR=1.8), heavy activities (P=0.03, OR=1.6) and consuming tea/coffee in men (P=0.01, OR=1.8) increased the chance of AMI. It was also discovered that triggers such as pulmonary infections, overeating and/or eating high-fat foods that are not dependent on demographic variables promoted the chance of AMI (P<0.05). Conclusion: All people - regardless of age, sex, and the presence/lack of underlying illness - are at risk of developing MI in the face of respiratory infections, overeating, and intake of high-fat foods. Also, sudden exposure to hot and / or cold weather, heavy activity and high consumption of coffee and/or tea, can increase the risk of MI in men.

Association of fish consumption and dietary intake of marine n-3 PUFA with myocardial infarction in a prospective Danish cohort study.

Several studies have investigated the potential benefits of marine n-3 PUFA in CVD, generally suggesting a lower risk of CHD. However, recent trials have questioned these results. This study investigated the association of fish consumption with dietary intake of marine n-3 PUFA with incident myocardial infarction (MI). In a Danish cohort study, 57 053 subjects between 50 and 64 years of age were enrolled from 1993 to 1997. From national registries, we identified all cases of incident MI. Dietary fish consumption was assessed using a semi-quantitative food questionnaire, including twenty-six questions regarding fish intake. In addition, we calculated the intake of total and individual marine n-3 PUFA. During a median follow-up of 17·0 years, we identified 3089 cases of incident MI. For both men and women, a high intake of fatty fish was inversely related to incident MI. Thus, when comparing the highest and the lowest quintile of fatty fish intake, we found a 12 % lower relative risk of MI in men (hazard ratio (HR) 0·88; 95 % CI 0·77, 1·00) and a 22 % lower relative risk in women (HR 0·78; 95 % CI 0·63, 0·96) after adjustments. For women, similar associations were observed for individual and total marine n-3 PUFA. In contrast, intake of lean fish was not associated with MI. In conclusion, incident MI was inversely related to a high intake of fatty fish, but not lean fish. However, test for trends across quintiles was not statistically significant. In general, this study supports the view that consumption of fatty fish may protect against MI.

Intake of whole grains is associated with lower risk of myocardial infarction: the Danish Diet, Cancer and Health Cohort

High intake of whole grains has been associated with lower risk of coronary heart disease; however, the research that has been used to evaluate different effects of different whole-grain cereals (e.g., wheat, rye, and oats) has been sparse. We investigated the association between whole-grain intake in terms of total intake and intakes of different cereals and myocardial infarction. This prospective study included 54,871 Danish adults aged 50-64 y, of whom 2329 individuals developed myocardial infarction (13.6 y of follow-up). Detailed information on daily intake of whole-grain products was available from a self-administered food-frequency questionnaire, and intakes of total whole grain and whole-grain species (wheat, rye, and oats) were estimated. The association between intake of whole grains and risk of myocardial infarction was examined with the use of a Cox proportional hazards model adjusted for potential confounders. For both men and women with total whole-grain intake in the highest quartile, lower risks of myocardial infarction were shown [HRs: 0.75 (95% CI: 0.65, 0.86) and 0.73 (95% CI: 0.58, 0.91), respectively] than for individuals with intake in the lowest quartile. When the specific cereal species were considered, rye and oats, but not wheat, were associated with lower myocardial infarction risk in men. No significant associations were seen in women. For total whole-grain products, significantly lower myocardial infarction risks were seen with higher intakes in both men and women. Rye bread (in men and women) and oatmeal (in men) were associated with significantly lower risk of myocardial infarction, whereas no significant association was shown for whole-grain bread, crispbread, and wheat. In this study, we provide support for the hypothesis that whole-grain intake is related to lower risk of myocardial infarction and suggest that the cereals rye and oats might especially hold a beneficial effect.

Abstract P009: Dietary Exposure to Polychlorinated Biphenyls and Incidence of Myocardial Infarction in Men - A Population-Based Prospective Cohort Study

Introduction: Fish consumption may promote cardiovascular health. The role of major food contaminants present in fish, such as polychlorinated biphenyls (PCBs) is, however, largely unexplored. Experimental studies indicate that PCBs cause endothelial cell dysfunction, hyperlipidemia and hypertension and cross-sectional associations have been observed between PCB-biomarkers and several intermediate risk factors for cardiovascular disease. PCBs accumulate and magnify in the food chain and fatty fish is a dominating source of exposure in populations with a relatively high fish intake. We assessed the hypothesis that dietary PCB exposure is associated with increased risk of myocardial infarction (MI) and that the exposure may mask a protective association with marine omega-3 fish fatty acids intake. Methods: Validated food frequency questionnaire-based estimates of dietary PCB exposure was obtained at baseline (1997) in 36,759 men from the population-based Cohort of Swedish Men, free of cancer, cardiovascular disease and diabetes. The estimated dietary PCB exposure was based on the food concentrations of PCB congener 153 at the time of baseline. PCB-153 is the most abundant congener in food and an excellent indicator for total PCB in food and in blood. The long-term dietary PCB exposure assessments showed acceptable validity against six PCB congeners in serum (correlation coefficients 0.30 to 0.58). Cases of MI were ascertained via register-linkage through 2010. Relative risks (RR) and 95% confidence intervals (CI) were adjusted for known cardiovascular risk factors. : Results During 12 years of follow-up (433,243 person-years), we ascertained 3,005 incident cases of MI. The major dietary sources of PCB exposure was fish, dairy products and meat. Compared with the lowest quintile of dietary PCB exposure (median 113 ng/day), men in the highest quintile (median 436 ng/day) had multivariable-adjusted RR of 1.22 (95% CI, 1.05-1.41) for MI, without adjusting for the intake of marine omega-3 fish fatty acids. In a separate model, we observed no association between the intake of marine omega-3 fish fatty acids and MI (RR, 1.07; 95% CI, 0.93-1.24). In mutually-adjusted models, dietary PCB exposure was associated with RR 1.72 (95% CI 1.28-2.30), and the intake of marine omega-3 fish fatty acids with RR, 0.67 (95% CI, 0.50-0.90), comparing highest quintiles with lowest. Conclusions: Exposure to an integrated measure of total PCBs from food was associated with increased risk of MI in men. The results may provide important information regarding the risk-benefit analysis of fish consumption. To increase the net benefits of fish consumption, PCB contamination should be reduced to a minimum: Future studies are needed to clarify the concentrations of PCBs that may offset the beneficial effects of fish consumption.

Interleukin 8 serum levels and the risk of myocardial infarction. Results from the Stockholm Heart Epidemiology program

Since its discovery during the late 80s, a large body of evidence suggests a key role of interleukin 8 (IL8) in the natural history of atherosclerosis from the early stages of vascular inflammation to the remodeling after myocardial infarction (MI). The aim of the present study was to evaluate the association of IL8 serum levels with the risk of MI in men and women from the Stockholm Heart Epidemiology Program (SHEEP), a case-control population with 2774 subjects (cases n=1213 and controls n=1561). Cases were identified as patients having been diagnosed with a non-fatal MI and controls were sex and age-matched subjects. Blood samplings were performed at least three months after the MI. IL8 (pg/ml) was measured in serum samples from 1133 controls and 714 cases using the Meso Scale Discovery's Multi-Array. IL8 serum levels were divided in quartiles according to IL8 distribution in controls (Q1≤ 8.3, Q2>8.3≤13.6, Q3>13.6≤20.9, Q4>20.9) In women, serum IL8 levels were higher in controls 14.2 (8.7-22.1) than in cases 11.6 (6.6-18.0) p= 0.0002 and strongly related to a protective effect of first time MI. Women with IL8 serum levels in the highest quartile (Q4) had an unadjusted OR of 0.44 (95% CI, 0.3-0.7), as compared to women exposed to low IL8 (Q1). Adjustments by insulin, BMI and CRP (OR [95% CI] = 0.41 [0.2-0.7]) and additional adjustment for the traditional cardiovascular risk factors (OR [95% CI] = 0.35 [0.2-0.6]) and by drug therapy (OR [95% CI] = 0.37 [0.2-0.8]) did not significantly change the risk estimates. In men serum levels of IL8 were higher in controls than in cases and associated with a reduced, however non-significant, MI risk. We report the largest investigation performed so far on the association between IL8 serum levels and the risk of MI. Our data demonstrates that in women high IL8 serum levels are associated with a reduced risk of MI. This may reflect a shift in the IL-8 properties during the different stages of the atherosclerotic process from a pro-inflammatory to an anti-inflammatory, pro-angiogenetic cytokine.

Vigorous physical activity, mediating biomarkers, and risk of myocardial infarction.

The effects of physical activity on risk of myocardial infarction (MI) are well documented and may include beneficial changes in blood lipids, inflammatory markers, and insulin sensitivity. The degree to which these and other traditional and nontraditional cardiovascular biomarkers mediate the inverse association between physical activity and risk of MI in men remains unclear. We conducted a nested case-control study among 18,225 men in the Health Professionals Follow-up Study followed from 1994 to 2004. A total of 412 men with incident MI were matched 1:2 with control participants on age and smoking status using risk-set sampling. From detailed responses to a modified Paffenbarger physical activity questionnaire, we determined the association between average hours of vigorous-intensity activity (activities requiring METs ≥ 6) and MI risk. For a 3-h·wk(-1) increase in vigorous-intensity activity, the multivariate relative risk (RR) of MI was 0.78 (95% confidence interval (CI) = 0.61-0.98). In models including preexisting CVD-related conditions, further adjustment for HDL-C, vitamin D, apolipoprotein B, and hemoglobin A1c attenuated the RR by 70% (95% CI = 12%-127%) to an RR of 0.93 (95% CI = 0.72-1.19). Participating in 3 h·wk(-1) of vigorous-intensity activity is associated with a 22% lower risk of MI among men. This inverse association can be partially explained by the beneficial effects of physical activity on HDL-C, vitamin D, apolipoprotein B, and hemoglobin A1c. Although the inverse association attributable to these biomarkers is substantial, future research should explore benefits of exercise beyond these biomarkers of risk.

Consumption of filtered and boiled coffee and the risk of first acute myocardial infarction; a nested case/referent study

Background and aim In northern Sweden, consumption of both filtered and boiled coffee is common. Boiled coffee, especially popular in rural areas, is known to raise blood lipids, a risk factor for acute myocardial infarction (MI). To our knowledge, only one epidemiological study, a case-control study from Sweden, has investigated boiled coffee in MI, noting an increased risk at high consumption levels in men, and no association in women. The aim of the present nested case-referent study was to relate consumption of filtered and boiled coffee to the risk of first MI. Methods and results The study subjects were 375 cases (303 men, 72 women) and 1293 matched referents from the population-based Northern Sweden Health and Disease Study. Coffee consumption was assessed by food frequency questionnaire. Risk estimates were calculated by conditional logistic regression. A statistically significant positive association was found between consumption of filtered coffee and MI risk in men [odds ratio for consumption ≥4 times/day versus ≤1 time/day 1.73 (95% CI 1.05–2.84)]. In women, a similar association was observed, but for boiled coffee [odds ratio 2.51 (95% CI 1.08–5.86)]. After adjustment for current smoking, postsecondary education, hypertension, and sedentary lifestyle, the results for women were no longer statistically significant. Conclusion Consumption of filtered coffee was positively associated with the risk of a first MI in men. A similar tendency was observed for boiled coffee in women, but the result was not statistically significant in multivariate analysis. Further investigation in a larger study is warranted.

Drinking Patterns and Myocardial Infarction: A Linear Dose–Response Model

The relation of alcohol intake to cardiovascular health is complex, involving both protective and harmful effects, depending on the amount and pattern of consumption. Interpretation of data available on the nature of these relations is limited by lack of well-specified, mathematical models relating drinking patterns to alcohol-related consequences. Here we present such a model and apply it to data on myocardial infarction (MI). The dose-response model derived assumes: (1) each instance of alcohol use has an effect that either increases or decreases the likelihood of an alcohol-related consequence, and (2) greater quantities of alcohol consumed on any drinking day add linearly to these increases or decreases in risk. Risk was reduced algebraically to a function of drinking frequency and dosage (volume minus frequency, a measure of the extent to which drinkers have more than 1 drink on days when they drink). In addition to estimating the joint impact of frequency and dosage, the model provides a method for calculating the point at which risk related to alcohol consumption is equal to background risk from other causes. A bootstrapped logistic regression based on the dose-response model was conducted using data from a case-control study to obtain the predicted probability of MI associated with current drinking patterns, controlling for covariates. MI risk decreased with increasing frequency of drinking, but increased as drinking dosage increased. Rates of increasing MI risk associated with drinking dosage were twice as high among women as they were among men. Relative to controls, lower MI risk was associated with consuming < 4.55 drinks per drinking day for men (95% CI: 2.77 to 7.18) and < 3.08 drinks per drinking day for women (95% CI: 1.35 to 5.16), increasing after these cross-over points were exceeded. Use of a well-specified mathematical dose-response model provided precise estimates for the first time of how drinking frequency and dosage each contribute linearly to the overall impact of a given drinking pattern on MI risk in men and women.

Variants in the coagulation factor 2 receptor (F2R) gene influence the risk of myocardial infarction in men through an interaction with interleukin 6 serum levels

Thrombin-activated factor 2 receptor (F2R) links thrombosis to inflammation modulating interleukin (IL)6 synthesis. We have investigated the role of F2R genetic variants and their interaction with IL6 serum levels in the occurrence of myocardial infarction (MI) in the Stockholm Heart Epidemiology Program (SHEEP). Seven SNPs -1738 G/A, -506-/GGCCGCGGGAAGC (D/I), 2860 G/A, 2930 T/C, 9113 C/A, 9333 C/T and 120813 T/C within F2R locus were genotyped in the SHEEP (n=2,774). The C allele at position 2930 was associated with a slight reduction in MI risk in men. IL6 serum levels were higher in male cases carrying genotypes AA at the -1738 (p= 0.01) and GG at the 2860 loci (p= 0.03) and both alleles were found to differentially modulate IL6 serum levels in the context of selective haplotypes. High IL6 serum levels (>75(th) percentile), were independently associated with an increased risk of MI in men with an odds ratio (OR) (95% confidence interval [CI]) of 2.44 (1.72-3.46), (p=0.0016), but not in women ( OR 0.83 [95%CI 0.50-1.36], p=0.64). In the presence of high IL6 serum levels, the -1738A allele increased and the 2860A allele reduced the risk of MI (all p < or = 0.02). Consistently, the AG diplotype increased MI risk (OR 1.71 [95%CI 1.17-2.51], p=0.005). The -1738 and 2860 loci association with IL6 serum levels was replicated in men in the Stockholm Coronary Artery Risk Factor (SCARF) study (both p < or = 0.04). In the pooled data from the two populations, the A and G allele modulated the risk of MI in men with high IL6 serum levels (p < or = 0.03). Our results demonstrate that in men F2R genetic variants influence the risk of MI mainly through an interaction with IL6 serum levels.

The cholesteryl ester transfer protein I405V polymorphism is associated with increased high-density lipoprotein levels and decreased risk of myocardial infarction: the Rotterdam Study

The effect of the cholesteryl ester transfer protein (CETP) I405V polymorphism on lipid levels, atherosclerosis and myocardial infarction (MI) was examined in 6421 participants from the Rotterdam Study. Quantitative outcomes were studied with linear models; Cox models were used to assess MI risk. High-density lipoprotein cholesterol (HDL) increased by 0.06 [95% confidence interval (CI): 0.03, 0.09] mmol/l in VV carriers. The V allele was further associated with decreased MI risk in men [hazard ratio (95% confidence interval)=0.57 (0.45, 0.73), VV versus II] (Ptrend=0.02). This study provides additional evidence for the association of CETP with HDL levels and suggests that CETP is an atherogenic protein increasing the risk of MI.

Interaction between inflammation-related gene polymorphisms and cigarette smoking on the risk of myocardial infarction in the Physician’s Health Study

Inflammation is known to be a major component of atherosclerosis, and cigarette smoking is known to induce a systemic inflammatory response. We therefore, investigated possible gene-environment interactions between various inflammation-related gene polymorphisms and cigarette smoking on the risk of myocardial infarction (MI) in the Physician's Health Study (PHS), a cohort of initially healthy middle-aged men. We used a nested case-control design consisting of 522 MI cases and 2,089 controls derived from PHS. Eleven inflammatory polymorphisms were studied using logistic regression analysis: eotaxin (ala23thr), intercellular adhesion molecule 1 (gly241arg), interleukin-4 (582C>T), interleukin-4 receptor (ile75val, gln576arg), interleukin-6 (-174G>C), interleukin-10 (-571C>A), P-selectin (val640leu, thr756pro, ser330asn), and vascular cell adhesion molecule 1 (-1594T>C). Interactions of smoking with all the three modes of inheritance (additive, dominant, recessive) were tested. Statistically significant (P<0.05) interaction terms were found for interleukin-4 receptor (ile75val), with odds ratios of 0.52 (95%CI:0.29-0.95) for Ile-Val and 0.34 (95%CI:0.14-0.83) for Val-Val, compared to the wildtype Ile-Ile; for interleukin-6 (-174G>C) with odds ratios of 2.16 (1.14-4.09) for GC and 0.81 (0.31-2.12) for CC, compared to the wildtype GG; and for P-selectin (ser330asn) with odds ratios of 0.48 (0.24-0.95) for Ser-Asn and 1.08 (0.29-3.93) for Asn-Asn, compared to the wildtype Ser-Ser, with these effects occurring only among the smokers. These data raise the possibility of interaction between the smoking status and certain inflammatory polymorphisms on the risk of MI in men. However, these results should be interpreted with caution due to the potential for false positive results that can arise from analyses with multiple comparisons.