Myocardial infarction and alcohol consumption: a population-based case-control study

Background and aimCoronary heart disease (CHD) is the leading cause of death in industrialized societies. Identifying and characterizing modifiable variables associated with CHD is an important issue for health policy. The aim of the present study was to analyze the association of non-fatal myocardial infarction with total alcohol consumption and type of alcoholic beverage consumed. Preference of the subjects' consumption for beer, wine, or spirits was set at 80% or more of total alcoholic beverage consumption.Methods and resultsA population-based case-control study (244 subjects and 1270 controls) was conducted. Male patients aged 25 to 74 years with first myocardial infarction (MI) were recruited in the same region as the healthy male controls, who were taken from a random sample representative of the Gerona population. Alcoholic beverage consumption during the preceding week was recorded. Multiple logistic regression analysis was performed to determine the association of alcohol consumption and non-fatal MI.Total alcohol consumption up to 30 g per day, adjusted for lifestyle and cardiovascular risk factors, was inversely associated (Odds ratio 0.14; 95% confidence interval 0.06–0.36) with the risk of non-fatal MI. Drinking up to 20 g of alcohol through wine, beer and spirits significantly decreased the adjusted risk of MI. Higher alcohol intake did not substantially reduce the risk. A preference for spirits was correlated with a significantly increased risk of non-fatal MI (P < 0.05).ConclusionModerate alcohol consumption, independent of the type of alcoholic beverage, was associated with non-fatal MI risk reduction.     

Alcohol drinking pattern and non-fatal myocardial infarction in women

AIMS: Evidence continues to emerge indicating the pattern of alcohol consumption has important implications for cardiovascular disease (CVD) risk, although the majority of studies have focused on men. The aim of the study is to examine the association between alcohol volume and various drinking patterns and non-fatal myocardial infarction (MI) in women aged 35-69 years. DESIGN AND SETTING: Population-based case-control study, 1996-2001. PARTICIPANTS: Incident MI cases (n = 320) recruited from Western NY hospitals, controls (n = 1565) identified from motor vehicle rolls and Health Care Financing Administration (HCFA) files. MEASUREMENTS: Incident MI, volume and drinking patterns for the 12-24 months prior to interview (controls) or MI (cases) were assessed in detail. FINDINGS: Of cases and controls, 13% were life-time abstainers; current drinkers averaged 2.3 +/- 2.2 drinks/drinking day. Compared to life-time abstainers, current drinkers tended to have a reduced likelihood of MI [odds ratio (OR), 0.67; 95% confidence interval (CI), 0.43-1.03]. Volume, drinks/drinking day and frequency were associated inversely with MI risk (P trends < 0.001). Wine drinkers (OR, 0.56; 95% CI, 0.33-0.96) and consumers of mixed beverage types (OR, 0.56, 0.31-1.01) had lower odds of MI compared to abstainers. Among current drinkers, for volume and most patterns, similar but somewhat weaker associations were noted than when abstainers were the reference. In contrast, frequency of intoxication at least once/month or more was associated with a strong increased risk compared to abstention (OR, 2.90; 95% CI 1.01-8.29) or in current drinkers, never drinking to this extent (OR, 6.22; 95% CI 2.07-18.69). CONCLUSION: In this population of light to moderate drinkers, alcohol consumption in general was associated with decreased MI risk in women; however, episodic intoxication was related to a substantial increase in risk.     

Coronary risk factors, development of myocardial infarction, and plasma oestrogens: a prospective case-control study in men

A number of studies have reported hyperoestrogenaemia in men surviving an acute myocardial infarction (AMI). This has led to speculations that hyperoestrogenaemia might be a coronary risk factor. It is not clear why plasma levels of oestrogens should be elevated in coronary heart disease. To ascertain whether hyperoestrogenaemia might be present before the onset of a myocardial infarction, we performed a prospective study in 252 men above the age of forty who within the following 5 years suffered an AMI and, as controls, 526 men matched for age and coronary risk factors and 329 randomly selected men. Mean plasma concentrations of oestradiol and oestrone did not differ significantly between the groups. This suggests that hyperoestrogenaemia is not a coronary risk factor and thus, if present after the AMI, is more likely develop concurrently with the myocardial infarction.     

Serum free fatty acid pattern and risk of myocardial infarction: a case-control study

Abstract. Yli‐Jama P, Meyer HE, Ringstad J, Pedersen JI (Medical Faculty, University of Oslo; National Health Screening Services, Oslo; and Østfold Central Hospital, Norway). Serum free fatty acid pattern and risk of myocardial infarction: a case‐control study. J Intern Med 2002; 251: 19–28. Objectives. To investigate the association between composition of serum free fatty acid (FFA) fraction and risk of a first myocardial infarction (MI). Design. A case‐control design. Setting. The patients were recruited from Ullevål Hospital in Oslo and Østfold Central Hospital in Fredrikstad and Sarpsborg, Norway. Subjects. A total of 103 patients with first MI and 104 population controls, both men and postmenopausal women, age 45–75 years. Results. The mean molar percentage content of docosahexaenoic (DHA), eicosapentaenoic (EPA), stearic and myristic acid in the serum FFA fraction was significantly lower in cases than in controls, whereas that of oleic and linoleic acid was higher in cases. Increased percentage content of total very long‐chain omega‐3 fatty acids (VLC n‐3) in serum FFA was associated with decreased risk of MI. Multivariate odds ratio (OR), adjusted for age, sex, waist‐hip ratio, smoking, family history of coronary heart disease (CHD) and years of education was 0.20 (95% CI 0.06–0.63) for the highest vs. lowest quartile. Also increased content of stearic acid was associated with decreased risk. Multivariate OR adjusted as above was 0.38 (95% CI 0.14–1.04) for the highest versus lowest quartile. After adjustment for oleic acid, however, the inverse linear trend was no longer significant. Conclusions. The percentage content of VLC n‐3 as well as of stearic acid in serum FFA was inversely associated with risk of myocardial infarction. That of VLC n‐3 may reflect diet, but additionally these free fatty acids might in some way be related to the pathogenetic process and not only reflect their content in adipose tissue.     

Tissue-type plasminogen activator and C-reactive protein in acute coronary heart disease. A nested case-control study

OBJECTIVES: To study the importance of inflammation and fibrinolysis for evolution of ischaemic heart disease in a cohort of initially healthy subjects. DESIGN: Nested case-control study. Follow-up periods 7-15 years. SUBJECTS: Included in the study were 133 cases with coronary heart disease and 258 controls. INTERVENTIONS: None. MAIN OUTCOME MEASURES: Subjects with ischaemic heart disease identified in 1991 by the Danish National Hospital Register. Protein concentration of C-reactive protein (CRP) and tissue-type plasminogen activator (t-PA) were measured with ELISA methods in stored serum samples. RESULTS: CRP and t-PA concentrations were both significantly higher in cases than in controls (P < 0.001 and P < 0. 001). This difference between cases and controls for CRP and t-PA was present in both men (CRP: P = 0.022; t-PA: P = 0.001) and women (CRP: P = 0.013; t-PA: P = 0.005) and it was present in both the 7-9 years follow-up cohort (CRP: P = 0.014; t-PA: P = 0.001) and the 15 years follow-up cohort (CRP: P = 0.027; t-PA: P = 0.012). The best predictor of CRP was t-PA, whilst the best predictor of t-PA was triglycerides. In a logistic regression analysis model, t-PA still came out as independent predictor of coronary heart disease, whilst such a significance disappeared for CRP. With the use of ROC curves we determined that AUC for t-PA was 0.62, and for CRP 0.59, indicating that none of these two analytes has a high prognostic power in predicting future coronary events in an initially healthy population. CONCLUSION: We conclude that moderate increases in serum concentrations of CRP and t-PA are present for up to 15 years before the presence of clinical overt coronary heart disease; that a low-grade inflammation is determined by other risk factors and that t-PA is an independent risk factor for evolution of coronary heart disease.     

Acute alcohol use and the risk of non-fatal injury in sixteen countries

AIMS: To determine the relative risk (RR) of non-fatal injury associated with alcohol consumption in a series of emergency departments (EDs), possible effect modifiers and the impact of contextual variables on differences across sites. DESIGN: The case-crossover method was used to obtain RR estimates of the effect of alcohol on non-fatal injuries. Meta-analysis was used to evaluate the consistency and magnitude of RR across sites, and the extent to which contextual variables explain differences in effect sizes. PARTICIPANTS: Probability samples of 11,536 injured patients attending 28 EDs studies in 16 countries (1984-2002). The majority of the sample was male (65%) and > 30 years old (53%). MEASUREMENTS: Exposed cases where those that consumed alcohol 6 hours prior to the injury. Usual alcohol consumption served as the control period. FINDINGS: Drinking within 6 hours prior to the injury was reported by 21% of the sample. The estimated (random) pooled relative risk for patients who reported alcohol use within 6 hours prior to injury was 5.69 (95% confidence interval = 4.04-8.00), ranging from 1.05 in Canada to 35.00 in South Africa. Effect size was not homogeneous across studies, as societies with riskier consumption patterns had a higher relative risk for injury. Heavier drinkers also showed lower RR. CONCLUSIONS: Acute alcohol was a risk factor for non-fatal injuries in most sites. Policy measures addressed to the general population are recommended, especially in societies with riskier consumption patterns.     

Non-alcoholic steatohepatitis and the risk of myocardial infarction:A population-based national study

BACKGROUND Non-alcoholic fatty liver disease(NAFLD) is a systemic disease with bidirectional relationships with cardiovascular disease(CVD). Non-alcoholic steatohepatitis(NASH) is a more severe subtype of NAFLD. Patients with NASH exhibit more intra and extrahepatic inflammation, procoagulant imbalances and proatherogenic lipid profiles. Whether NASH increases the risk of ischemic heart disease is currently unclear.AIM To investigate the relationship between acute myocardial infarction(MI) and NASH in a large cohort of subjects in the United States.METHODS We reviewed data from a large commercial database(Explorys IBM) that aggregates electronic health records from 26 large nationwide healthcare systems. Using systemized nomenclature of clinical medical terms(SNOMED CT), we identified adult with the diagnosis of NASH from 1999-2019. We included patients with the diagnosis of acute MI from 2018-2019. Comorbidities known to be associated with NASH and MI such as obesity, diabetes mellitus, hyperlipidemia, smoking, male gender, and hypertension were collected. Univariable and multivariable analyses were performed to investigate whether NASH is independently associated with the risk of MI.RESULTS Out of 55099280 patients, 43170 were diagnosed with NASH(0.08%) and 107000(0.194%) had a MI within 2018-2019. After adjusting for traditional risk factors, NASH conferred greater odds of MI odds ratio(OR) 1.5 [95% confidence interval(CI): 1.40-1.62]. Hyperlipidemia had the strongest association with MI OR 8.39(95%CI: 8.21-8.58) followed by hypertension OR 3.11(95%CI: 3.05-3.17) and smoking OR 2.83(95%CI: 2.79-2.87). NASH had a similar association with MI as the following traditional risk factors like age above 65 years OR 1.47(95%CI: 1.45-1.49), male gender OR 1.53(95%CI: 1.51-1.55) diabetes mellitus OR 1.89(95%CI: 1.86-1.91).CONCLUSION MI appears to be a prevalent disease in NASH. Patients with NASH may need early identification and aggressive cardiovascular risk modification.     

Alcohol consumption, drinking pattern and acute myocardial infarction. A case referent study based on the Swedish Twin Register

Objectives. Little is known about the possible influence of different kinds of alcohol drinking pattern on the risk of acute myocardial infarction. In this study the association between average daily alcohol consumption, as well as large intakes of alcohol on single occasions, and myocardial infarction incidence was investigated.
Design. A case referent analysis nested within a prospective cohort study.
Setting. Incident cases of myocardial infarction were identified by using hospital discharge data and deaths. Referents were selected from the study population through a stratified random sample.
Subjects. Individuals of the Swedish Twin Register below 75 years of age living in a region of 10 Swedish counties in 1972–1981 or in Stockholm County in 1972–1987.
Main outcome measure. Incidence of acute myocardial infarction.
Results. No difference in myocardial infarction incidence was found between former alcohol drinkers and lifelong abstainers. For men, drinkers had a 40% lower incidence than non-drinkers, as did those with a drinking pattern involving a large intake on single occasions. Women had on average a very low level of alcohol consumption and there were only small differences in incidence of myocardial infarction between drinkers and non-drinkers. An increased incidence was indicated for women reporting sometimes drinking comparatively large amounts of alcohol on single occasions.
Conclusions. The results support the suggestion that low and moderate alcohol consumption is protective for myocardial infarction. A drinking pattern involving a large intake of alcohol on single occasions did not seem to substantially influence myocardial infarction incidence except possibly for women with an overall very low level of consumption.     

Association of hepatitis C infection and acute coronary syndrome: A case-control study

Infections with hepatitis C virus (HCV) represent a substantial national and international public health burden. HCV has been associated with numerous extrahepatic conditions and can lead to metabolic derangements that are associated with atherosclerosis and cardiovascular disease. We investigated whether HCV infection is associated with an increased number of acute coronary syndrome (ACS) events among hospitalized patients in an inner-city tertiary hospital.We performed a matched (age, sex, and race/ethnicity) case-control study on patients at least 18 years old admitted to inpatient medical and cardiac services at the University of Maryland Medical Center from 2015 through 2018. The primary outcome was ACS and the primary exposure was HCV infection. Covariates of interest included: alcohol use, tobacco use, illicit drug use, hypertension, diabetes mellitus, human immunodeficiency virus infection, body mass index, dyslipidemia, and family history of coronary heart disease. Covariates with significant associations with both exposure and outcome in bivariate analyses were included in the multivariable analyses of the final adjusted model.There were 1555 cases and 3110 controls included in the final sample. Almost 2% of cases and 2.4% of controls were HCV infected. In adjusted models, there was no significant association found between experiencing an ACS event in those with HCV infection compared to those without HCV infection (odds ratio 0.71, 95% confidence interval 0.45–1.11).We found no significant association between HCV infection and ACS in our study population. However, given the mixed existing literature, the association between HCV and ACS warrants further investigation in future prospective cohort and/or interventional studies.     

Myocardial bridging: a cause of myocardial infarction?

A 50-year-old man was admitted to hospital because of severe and progressive chest pain at rest. Selective coronary arteriography revealed occlusion of the left anterior descending artery at the origin of an intramural course. Intracoronary thrombolysis restored the patency of the otherwise completely normal vessel but did not fully prevent myocardial infarction.     

Procoagulant factors and the risk of myocardial infarction in young women

Abstract:  Objectives:  We investigated whether elevated levels of factor VIII, IX and XI is associated with myocardial infarction (MI) in young women. In addition, we studied ABO blood group, von Willebrand factor (VWF) and C-reactive protein (CRP). Methods and results:  We compared 200 women with MI before age 49 years with 626 controls from a population-based case–control study. Mean levels of factor VIII activity (VIII), von Willebrand factor antigen (VWF), factor IX activity (IX) were higher in patients (133, 134 and 132 IU/dL) than in controls (111, 107 and 120 IU/dL, respectively). Mean levels of factor XI (XI) were equal in patients (114 IU/dL) and controls (113 IU/dL). The odds ratio (OR) for MI for blood group non-O vs. O was 1.6 [95% confidence interval (CI) 1.1–2.3]. The OR adjusted for age, index year and area of residence for the highest quartile >150 IU/dL of factor VIII was 2.7 (95% CI 1.6–4.6), of VWF 4.7 (95% CI 2.3–9.7), of factor IX 2.6 (95% CI 1.3–5.4) and of factor XI 0.9 (95% CI 0.5–1.4), all compared with the lowest quartile <100 IU/dL. Conclusions:  Non-O blood group, high VWF, factor VIII and factor IX levels are associated with an increased risk of MI in young women, while high factor XI levels are not.     

Tobacco smoking and risk of haematological malignancies in adults: a case–control study

A retrospective study was conducted in 1216 cases to investigate the possible association between tobacco smoking and the risk of haematological malignancies. A small, but not significant, increase in malignancy was observed in smokers. Significant association was demonstrated between tobacco smoking and acute non-lymphoblastic leukaemia, and myelodysplastic syndromes. The duration and amount smoked increased the risk; heavy smokers presented significant positive associations with overall malignancies, acute nonlymphoblastic leukaemia, myelodysplastic syndromes, and monoclonal gammopathy of undetermined significance, whereas light smokers did not present any significant association. These data support a causal relationship between certain haematological malignancies and tobacco smoking. Further research is needed to examine the risk according to dose–response effect, and the variation in risk according to the histological subtype of the malignancy.     

Suicidal behaviour and associated risk factors among opioid-dependent individuals: a case-control study

AIMS: To examine suicidal behaviour and the associated risk factors among opioid-dependent cases and non-opioid-dependent controls. DESIGN: Case-control study. SETTING: Sydney, Australia. PARTICIPANTS: A total of 726 opioid-dependent cases and 399 non-opioid-dependent controls, matched on age, sex and employment status. FINDINGS: Cases had significantly higher life-time prevalence of suicidal thoughts (66% versus 55%), suicide attempts (31% versus 20%) and multiple attempts (19% versus 11%) compared to controls. Cases were significantly more likely to indicate a severe intent to die (63% versus 43%). Both cases and controls who had attempted suicide were significantly more likely than others to suffer from substance use and psychological disorders, as well as childhood maltreatment. Risk factors which predicted suicide attempts were the same among cases and controls, including screening positive for borderline personality disorder, post-traumatic stress disorder and persistent suicidal thoughts. CONCLUSIONS: Although controls had elevated levels of suicidal behaviour compared to those seen in general population surveys, the prevalence of suicidal behaviour among cases was still much higher. Although opioid dependence was related to suicidal behaviour, it did not make a unique contribution to the risk of suicide attempts over and above the other risk factors identified.     

The common pentanucleotide polymorphism of the 3'-untranslated region of the leptin receptor gene is associated with serum insulin levels and the risk of type 2 diabetes in non-diabetic men: a prospective case-control study

OBJECTIVES: The purpose of the study was to test whether the pentanucleotide insertion/deletion polymorphism in the 3'-untranslated region (3'-UTR) of the leptin receptor gene, which has previously been associated with serum insulin levels in obese subjects, is associated with insulin levels and the risk of type 2 diabetes in non-diabetic middle-aged men. SUBJECTS AND DESIGN: We studied these associations in a prospective population-based nested case-control study in 41 men who developed type 2 diabetes during 4-year follow-up and 81 controls who were matched for age, obesity, baseline glucose and insulin and other strongest risk factors. Both the cases and the controls came from a cohort of 985 men who had no diabetes at baseline. RESULTS: There was one homozygote and 22 heterozygotes for the 3'-UTR insertion allele amongst all 122 men. The carrier frequency of this allele was 9.8% amongst the cases and 23.5% amongst the controls. At baseline, the mean fasting serum insulin was 12.2 mU L-1 in the 23 men who were heterozygous or homozygous for the insertion allele and 17.1 mU L-1 in the 99 men who were homozygous for the deletion allele (P = 0.005). In a logistic regression model adjusting for four strongest non-matched predictors of type 2 diabetes, the carriers of the insertion allele had a 79% reduced risk of diabetes (OR = 0.21; 95% CI = 0.06-0.77, P = 0.019), compared with non-carriers. CONCLUSION: Our findings support the hypothesis that alterations in the leptin signalling system could contribute to serum insulin levels and the development of type 2 diabetes.