Acute myocardial infarction: psychosocial and cardiovascular risk factors in men.

BACKGROUND: Controversy still exists over the independent role of psychosocial factors in acute myocardial infarction (AMI). This study aimed to compare psychometric indices in Portuguese patients surviving a first episode of AMI and a community sample free of AMI. DESIGN: A community-based, case-control study. The study sample included 153 male patients with a first episode of AMI and 156 male controls randomly selected from the community. METHODS: Information on demographic, social, medical and behavioural characteristics was obtained using a structured questionnaire; anthropometric, blood pressure, and serum measurements were performed, and the psychometric evaluation was obtained using a self-evaluation questionnaires (Bortner scale, Beck Depression Inventory, SCL-90-R, Psychological General Well-Being and the Nottingham Health Profile). RESULTS: Cases of AMI more often exhibited type A behaviour (15.4 +/- 3.0 versus 14.7 +/- 2.7, P = 0.041), had more depressive symptoms (10.8 +/- 8.0 versus 8.6 +/- 8.0, P = 0.005) and showed worse scores on general well-being (68.4 +/- 17.7 versus 76.6 +/- 16.2, P < 0.001) than controls. Cases were significantly different from controls in terms of years of education (6.7 +/- 4.4 versus 9.0 +/- 4.7 years, P < 0.001), hypertension (43.1% versus 30.1%, P = 0.024), dislipidaemia (43.8% versus 34.0%, P = 0.038), type I obesity (53.6% versus 42.3%, P = 0.045), smoking (54.1% versus 26.5%, P < 0.001), no practise of exercise (68.5% versus 50.3%, P = 0.002) and presence of non-insulin-dependent diabetics (16.3% versus 6.4%, P = 0.010). After adjusting for such factors a similar set of significant psychometric results was found. CONCLUSION: Type A behaviour, depression and lower levels of well-being and quality of life, independent of other cardiovascular risk factors, were significant features of AMI cases.     

C-reactive protein, cardiovascular risk factors and the association with myocardial infarction in men

OBJECTIVES: This study had three objectives: first, to investigate the association of C-reactive protein levels and myocardial infarction amongst men; secondly, to study the associations of C-reactive protein levels with cardiovascular risk factors; and thirdly, to adjust the risk of myocardial infarction for such factors. DESIGN AND SUBJECTS: A case-control study including 560 patients with a first myocardial infarction who had survived at least 6 months, plus 646 control subjects. RESULTS: Patients had significantly higher levels of C-reactive protein (mean 2.2 mg L-1) than control subjects (mean 1.7 mg L-1; P < 0.001). Persons in the highest quintile of C-reactive protein had an unadjusted 1.9-fold increased risk of myocardial infarction compared with persons in the lowest quintile (odds ratio 1.9, 95% CI: 1.3-2.7). C-reactive protein was, in addition to smoking, associated with several cardiovascular risk factors: age, obesity, diabetes, blood pressure, triglycerides and inversely associated to HDL cholesterol. Adjustment for these variables, especially for total cholesterol, HDL cholesterol and triglycerides, substantially decreased the risk of myocardial infarction for persons in the highest quintile of C-reactive protein, compared to those in the lowest quintile, to 1.3 (95% CI: 0.9-1.9). CONCLUSIONS: Our findings confirm previous reports that C-reactive protein predicts the risk of myocardial infarction. However, this association does not appear to be causal, since the increase in risk can to a large extent be explained by the presence of other cardiovascular risk factors.     

Prothrombotic coagulation defects and cardiovascular risk factors in young women with acute myocardial infarction

We investigated the effect of prothrombotic coagulation defects in combination with smoking and other conventional risk factors on the risk of myocardial infarction in young women. In 217 women with a first myocardial infarction before the age of 50 years and 763 healthy control women from a population-based case-control study, factor V Leiden and prothrombin 20210A status were determined. Data on major cardiovascular risk factors and oral contraceptive use were combined with the presence or absence of these prothrombotic mutations, and compared between patients and controls. The overall odds ratio for myocardial infarction in the presence of a coagulation defect was 1.1 [95% confidence interval (CI) 0.6-1.9]. The combination of a prothrombotic mutation and current smoking increased the risk of myocardial infarction 12-fold (95% CI 5.7-27) compared with non-smokers without a coagulation defect. Among women who smoked cigarettes, factor V Leiden presence versus absence increased the risk of myocardial infarction by 2.0 (95% CI 0.9-4.6), and prothrombin 20210A presence versus absence had an odds ratio of 1.0 (95% CI 0.3-3.5). We conclude that factor V Leiden and prothrombin 20210A do not add substantially to the overall risk of myocardial infarction in young women. However, in women who smoke, the presence of factor V Leiden increased the risk of myocardial infarction twofold.     

Somatic risk factors for myocardial infarction among Swedish railway engine drivers

BACKGROUND: Previous studies have indicated an increased incidence of myocardial infarction among railway engine drivers. OBJECTIVE: To analyse whether somatic risk factors for myocardial infarction among male drivers in different geographical areas in Sweden differed from that in general population samples drawn from the same geographical areas. DESIGN: A cross-sectional study comparing drivers and men from the general population. METHODS: Engine railway drivers aged 25-59 years (n = 2318) were compared with randomly selected men (n = 3016) with respect to their serum cholesterol, systolic and diastolic blood pressures and smoking habits. RESULTS: The levels of the risk factors did not differ between engine drivers and the reference groups except for the Stockholm area which showed a higher percentage of tobacco smokers as well as higher means for systolic and diastolic blood pressures. The risk ratio compared with the reference samples was significantly elevated in Stockholm but not in any of the other areas. CONCLUSIONS: These somatic risk factors for myocardial infarction do not explain the approximately 40% reported increase in myocardial infarction incidence among railway engine drivers. In the following study, psychosocial factors will also be examined.     

Conditional risk factors in men with previous myocardial infarction: relevance of C3 and homocysteine.

OBJECTIVE: To establish which traditional and conditional risk factors were effectively treated, and which remained active, in patients with previous myocardial infarction (PMI). METHODS AND RESULTS: In 47 PMI patients recently submitted to cardiological assessment and in 42 controls (50-70 years old men), traditional risk factors (total cholesterol, high-density lipoprotein cholesterol, blood glucose, blood pressure, cigarette smoking and body mass index) and the following variables were measured: fibrinogen, plasminogen activator inhibitor-1 (PAI-1), lipoprotein(a) [Lp(a)], total homocysteine, plasma folates, vitamin B12, high sensitivity C-reactive protein and C3 complement. Most patients were taking beta-blockers, ACE inhibitors and statins. Accordingly, patients had lower blood pressure and cholesterol values than controls. Moreover, they consumed less alcohol and coffee and did not differ from controls in cigarette smoking and body mass index. Conversely, patients had higher levels of homocysteine, fibrinogen, C3 complement and Lp(a), although of these factors only C3 and homocysteine remained significantly associated with PMI in multivariate analysis. C-reactive protein, PAI-1 and especially C3 often correlated with traditional risk factors in controls, but these correlations tended to disappear or reverse in PMI patients. Fibrinogen inversely correlated with alcohol consumption. Homocysteine correlated (inversely) with plasma folates only. Lp(a) did not correlate with any variable. CONCLUSIONS: Forty-seven patients with previous myocardial infarction displayed an excellent control of traditional risk factors, but they had higher mean C3 and homocysteine levels than the control group.     

Platelet activation in young men after myocardial infarction: its relation to metabolic coronary risk factors]

Selected parameters of platelet function as well as their relationship with metabolic coronary risk factors are studied in a group of 40 young survivors (aged 30-40 years) of myocardial infarction, now presenting stable coronary disease. Nineteen healthy men, of approximately similar age-span, constituted the control group. The following parameters were determined: platelet survival half-time (via non-isotope method), intraplatelet activity of cyclooxygenase and lipoxygenase pathway of arachidonic acid (by measurements of malondialdehyde concentration before and after incubation with acetylsalicylic acid acid) and 125-I-fibrinogen binding to platelets. Moreover, the plasmatic concentration of total cholesterol, HDL-cholesterol, triglycerides, phospholipids, Apo A and B, total beta lipoproteins, glucose, uric acid as well as percentages of beta, prebeta, alpha lipoproteins and glycosylated hemoglobin were also studied. Platelet survival half-time in patients was significantly shortened (3.64 +/- 1.37 days) when compared with the control group (4.97 +/- 1.7 days). A higher intraplatelet activity of lipoxygenase pathway (2.02 +/- 0.62 and 1.49 +/- 0.54 nmol MDA/10(9) platelets, respectively) was also found. However, activity of cyclooxygenase pathway of arachidonic acid and 125-I-fibrinogen binding to platelets remained unchanged. Shortened platelet survival half-time and the hyperactivity of intraplatelet lipoxygenase pathway correlated with a reduced plasmatic concentration of HDL-cholesterol (r = 0.323, p less than 0.05 and r = -0.451, p less than 0.05, respectively). The remaining parameters of platelet function were not statistically related to metabolic risk factors. The values of platelet function indicators in subgroups of patients divided according to family history of coronary heart disease, oral glucose load test result, and submaximal exercise test result did not differ significantly.(ABSTRACT TRUNCATED AT 250 WORDS)     

Activation of clotting factors XI and IX in patients with acute myocardial infarction

In acute coronary events, plaque rupture and the subsequent formation of the catalytic tissue factor-factor VIIa complex is considered to initiate coagulation. It is unknown whether clotting factors XI and IX are activated in acute coronary events. Therefore, we prospectively investigated the activation of clotting factors XI and IX as well as activation of the contact system and the common pathway in 50 patients with acute myocardial infarction (AMI), in 50 patients with unstable angina pectoris (UAP), and in 50 patients with stable angina pectoris (SAP). Factor XIa-C1 inhibitor complexes, which reflect acute activation of factor XI, were detected in 24% of the patients with AMI, 8% of the patients with UAP, and 4% of the patients with SAP (P<0.05), whereas factor XIa-alpha(1)-antitrypsin complexes, which reflect chronic activation, were observed equally in all 3 study groups. Factor IX peptide levels were significantly higher in the patients with AMI and UAP compared with the patients with SAP (P<0.01). No differences regarding markers of the common pathway were demonstrated. Fibrinopeptide A levels were elevated in patients with AMI compared with patients with UAP and those with SAP (P<0.01). Factor XIIa- or kallikrein-C1 inhibitor complexes were not increased. In conclusion, this is the first demonstration of the activation of clotting factors XI and IX in patients with acute coronary syndromes. Because these clotting factors are considered to be important for continuous thrombin generation and clot stability, their activation might have clinical and therapeutic consequences.     

Psychosocial risk factors for myocardial infarction among Swedish railway engine drivers [corrected

BACKGROUND: Several earlier investigations have found an increased incidence of myocardial infarction among male drivers and, not least, among railway engine drivers. In a previous study we found that increased serum cholesterol, blood pressure or tobacco smoking did not explain this increased risk. OBJECTIVE: To investigate psychosocial factors and primarily work-related factors among male engine drivers. DESIGN: Engine drivers were compared with random population samples in a cross-sectional study. METHOD: Two thousand three hundred and eighteen engine drivers aged 25-59 years were compared with 331 randomly selected men who were mainly from the G?teborg MONICA population study. Job demands and job decision latitude as well as social support were the main factors compared. RESULTS: Job demands were reported as being significantly lower by both younger and older engine drivers compared to their referents (P = 0.002 and P = 0.0001, respectively). Decision latitude was reported as being lower by both younger and older engine drivers than among controls (P = 0.0001 for both groups). Engine drivers experienced deficient support from their superiors compared to the referents (P = 0.0001 for younger as well as older engine drivers). Low decision latitude was associated with significantly higher diastolic blood pressure (r = -0.11 and P = 0.0001), but otherwise there were no significant relationships between psychosocial work characteristics and somatic risk factors. CONCLUSIONS: The combination of low decision latitude and low social support seems to be a key factor in the increased risk of myocardial infarction among railway engine drivers. They generally undertake shift work which may be an additional risk factor for myocardial infarction.     

急性脑梗死和心肌梗死危险因素的对比分析

目的 探讨急性脑梗死与急性心肌梗死危险因素的异同.方法 分析115例急性脑梗死患者和108例急性心肌梗死患者的性别、年龄、高血压病史、糖尿病史、生活方式因素等以及入院后血糖、血脂、尿酸、纤维蛋白原等生化资料.结果 急性脑梗死患者高血压病发病率、血清胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)水平高于急性心肌梗死患者(P＜0.05);急性心肌梗死患者尿酸(UA)、纤维蛋白原(FIB)水平高于脑梗死患者(P＜0.01或P＜0.05).结论 高血压与TC、LDL-C水平作为发病危险因素与脑梗死的密切程度高于心肌梗死;纤维蛋白原和尿酸异常在急性心肌梗死的发病中可能有更明显的作用.     

Coronary risk factors in newly diagnosed and previously diagnosed type 2 diabetic men with myocardial infarction

Risk factors for coronary artery disease in 131 known non-insulin-dependent (type 2) diabetic patients is compared to that in 115 newly diagnosed type 2 diabetic subjects and in 316 non-diabetic patients. The subjects, all Indian men aged 21-60 years, represent consecutive survivors of myocardial infarction and were investigated 3-4 months after their acute episode. A group of 524 healthy Indian men aged 21-60 years were included as controls. Significant differences in parameters measured were noted when all diabetic and non-diabetic patients were compared to the control group. Diabetic patients were older than the non-diabetic patients and with significantly higher frequency of hypertension and hypertriglyceridaemia, whilst smoking and family history of coronary artery disease were elicited more frequently in the non-diabetic patients. Mean concentrations of serum total cholesterol and lipoproteins in the diabetic and non-diabetic men were similar, whereas serum triglyceride concentrations were significantly higher in the diabetic patients. Newly diagnosed and known diabetic patients did not differ with respect to the risk factors examined. Clusters of various combinations of hypertension, obesity, hypertriglyceridaemia and low HDL-cholesterol values were encountered more frequently in diabetic patients when compared to non-diabetic patients, whilst no significant differences were observed when the two groups of diabetic subjects were compared. In conclusion, this study has demonstrated that in men with myocardial infarction there are significant differences between diabetic and non-diabetic patients with respect to certain risk factors. However, newly diagnosed diabetic men have similar risk profiles to their known diabetic counterparts.     

A prospective study of the association between APOE genotype and the risk of myocardial infarction among apparently healthy men

BACKGROUND: Apolipoprotein E (apoE) plays an important role in lipid metabolism. Three common alleles in the APOE gene, E2/E3/E4, have been associated with lipoprotein disorders but their effects on myocardial infarction (MI) risk remain uncertain. METHODS: In a prospective cohort of 14916 apparently healthy men enrolled in the Physicians' Health Study, APOE genotyping was conducted to determine three common alleles (E2/E3/E4) among 385 incident cases of first MI and among 373 age- and smoking-matched controls. RESULTS: No significant differences in allele or genotype frequency for the APOE gene were detected between cases and controls. As expected, we observed significant positive associations between dyslipidemia (low HDL/high TG or high LDL) and MI risk (P<0.001) and between genotypes and levels of LDL (P<0.001), HDL (P=0.04) or TG (P=0.02). Compared with men homozygous for the E3 allele and after adjusting for multiple MI risk factors, men carrying the E4 allele (E4/4 or E4/3) had a relative risk of 0.93 (95% CI 0.63-1.37) and men carrying the E2 allele (E2/2 or E2/3) a relative risk of 1.03 (0.62-1.74). Moreover, no significant difference in MI risk was observed among different genotypes across different levels of lipids or smoking status. CONCLUSIONS: These data from a prospective study of apparently healthy men do not support the simple view of E2 as a protective factor and E4 as a susceptibility factor in predicting future risk of MI independent of lipid parameters. Nor did we observe any interaction between smoking and apoE4 allele on MI risk.     

Hageman factor and risk of myocardial infarction in middle-aged men.

In order to evaluate whether Hageman factor (XII) is increased in survivors of myocardial infarction and whether this in turn influences factor VII coagulant activity (VIIc), we examined the coagulation and lipoprotein profiles in 82 subjects, 51 of whom had a definite history of myocardial infarction and 31 healthy volunteers invited from a local general practice register for a cardiovascular screen. Both serum cholesterol (P = 0.03) and plasma fibrinogen levels (P = 0.02) were significantly elevated in cases compared with controls. There were no significant differences in coagulant activities, and in particular factor XII concentration was not significantly different between groups. Furthermore, in 47 of the subjects, 28 of whom had a history of myocardial infarction, a more detailed analysis, including measurement of VIIc after overnight incubation of plasma at 4 degrees C, was undertaken. Approximately half the subjects in either group showed some evidence of activation, though history of myocardial infarction was not in itself a significant predictor of this. All measures of XII concentration related positively to VIIc after cold activation, the strongest being the measure of amidolytic activity following activation of factor XII (XIIAm) (r = 0.5, P < 0.01). In addition, XIIa, a measure of activity due to enzymes derived from factor XII, related strongly to many of the measured lipoprotein variables, particularly VLDL cholesterol and triglycerides, supporting the hypothesis that negatively charged molecules such as free fatty acids on larger lipoprotein particles provide the contact surface necessary to activate factor XII. The findings confirm the importance of this alternative pathway in leading to activation of factor VII.     

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.     

Joint effects of Chlamydia pneumoniae infection and classic coronary risk factors on risk of acute myocardial infarction

Background

Although not in itself strongly predictive of coronary heart disease, Chlamydia pneumoniae infection could interact with classic risk factors in determining risk of acute myocardial infarction (AMI).

Methods

We assessed C pneumoniae immunoglobulin (Ig) G and IgA titers and classic risk factors in 618 patients with AMI and in 967 controls.

Results

IgG titers were not related to AMI, but a significant association was seen between IgA titers and AMI. Excess risk of AMI was noted mainly among patients with the highest IgA titers, such as those beyond 2.88 (the 95th percentile cutoff point in control subjects), showing a 1.8-fold increase in risk (odds ratio 1.75, 95% CI 1.04-2.92). Classic risk factors did not differ between subjects with IgA titers above and below the 95th percentile cutoff. However, in multivariate analyses, models incorporating both IgA titers and a classic risk factor such as obesity, hypercholesterolemia, or smoking predicted risk more effectively than single-parameter models. For example, the odds ratio for AMI among subjects with the highest IgA titers plus hypercholesterolemia was greater than the product of individual risks associated with these high IgA titers and with hypercholesterolemia.

Conclusions

Interactions with classic risk factors (ie, obesity, hypercholesterolemia, and smoking), increased the predictive value of C pneumoniae IgA antibody titers in determining risk of AMI.     

High prevalence of thrombophilia among young patients with myocardial infarction and few conventional risk factors

BACKGROUND: Thrombophilia refers to series of acquired and inherited conditions that confer a tendency to thrombus formation. The exact relationship between thrombophilia and MI is not well established. OBJECTIVES: To determine the prevalence of thrombophilia in young patients with their first MI and few conventional risk factors. METHODS: We evaluated the baseline characteristics and the thrombophilia profile, including anti-cardiolipin antibodies, activated protein C resistance (APCR) with the factor V Leiden mutation, prothrombin G20210A mutation, protein C, protein S, and antithrombin-III levels, among 85 consecutive patients (<50 year old) who were admitted to CCU with their first MI. Patients were divided into two groups: group A-patients with < or =1 risk factor and group B-patients with > or =2 risk factors. RESULTS: 92% were male and 55% with anterior wall MI. Overall, the risk factor profile was: smoking in 60%, hyperlipidemia in 42%, positive family history in 29%, hypertension in 18%, diabetes mellitus in 13%, and obesity in 8%. Forty-seven percent of patients had < or =1 risk factor (n=40, group A) and 53% had > or =2 risk factors (n=45, group B). The prevalence of the prothrombin mutation was 15% in group A compared to 7% in group B (p=0.12). APCR secondary to a heterozygous genotype of factor V Leiden mutation was found in 20% in group A compared to 2% in group B (p<0.01). Anti-cardiolipin antibodies were found in 16% in group A compared to 22% in group B (p=ns). Finally, we have found that the likelihood of identifying at least one thrombophilia marker was 50% in group A compared to 29% in group B (p=0.046). CONCLUSIONS: The likelihood to detect at least one thrombophilia marker in young patients with MI and few conventional risk factors is significantly high. Thrombophilia may contribute to the development of MI in this specific group of young patients.     

Post-traumatic stress disorder following myocardial infarction: Prevalence and risk factors

BACKGROUND:

Post-traumatic stress disorder (PTSD) is associated with negative impacts on physical health. Victims of a myocardial infarction (MI) who develop PTSD may be particularly affected by these impacts due to their cardiovascular vulnerability. Post-traumatic reactions in this population are not well known.

OBJECTIVES:

To examine the prevalence of PTSD after MI and its risk factors, and to validate a prediction model for PTSD symptoms.

METHODS:

Patients hospitalized for MI (n=477) were recruited in three hospitals. The Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, and questionnaires concerning PTSD symptoms and general measures were administered to patients during hospitalization and at one-month follow-up.

RESULTS:

Four per cent of the patients had PTSD and 12% had partial PTSD. The perception of a threat to life, the intensity of acute stress disorder and depression symptoms several days after the MI, a history of referral to a psychologist or psychiatrist, and female sex were risk factors for the intensity of PTSD symptoms in a sequential multiple regression analysis (R=0.634). The prediction model was validated by applying the regression equation to 48 participants who were not included in the initial regression (R=0.633).

CONCLUSIONS:

The risk factors for development of PTSD symptoms identified in the present study could be used to facilitate the detection of patients at risk for developing PTSD symptoms so they can later be offered psychological interventions as needed.     

Secular changes in cardiovascular risk factors and attack rate of myocardial infarction among men aged 50 in Gothenburg, Sweden. Accurate prediction using risk models

Aims. Coronary risk factor changes were related to attack rate of acute myocardial infarction (AMI). Methods and results. Cross‐sectional population samples of 50‐year‐old men were examined every 10th year from 1963 to 2003. Attack rates of AMI were recorded from 1975 to 2004. Prevalence of smoking decreased from 56% in 1963 to 22% in 2003. Leisure time physical activity decreased (n.s.), while psychological stress remained the same. Diabetes prevalence increased from 3.6% to 6.6%. Body mass index (BMI) increased from 24.8 to 26.4 kg m^?2. Blood pressures decreased from 138.2/90.6 to 134.7/84.9 mmHg (P = 0.00001). Serum total cholesterol decreased from 6.42 to 5.50 mmol L^?1 (P = 0.0001), but serum triglycerides increased from 1.26 to 1.71 mmol L^?1 (P = 0.0001). The multivariable risk according to total cholesterol, blood pressure and smoking for AMI decreased from the set value 1.0 in 1963 to 0.418. From 1975–1979 to 2000–2004 attack rates for AMI for the age groups 35–44, 45–54 and 55–64 declined to 45%, 46% and 45%, respectively. The 28‐day case fatality declined from 30%, 38% and 46% to 12%, 16% and 20%. Conclusion. The more than 50% decline in attack rate of AMI during 30 years was comparable with the decline in risk factors.     

天津市市区成人心肌梗死的流行病学特征及相关因素分析

目的了解天津市市区成人心肌梗死的流行病学特征和相关危险因素,为天津市市区心肌梗死的防治和干预提供科学依据。方法以整群随机抽样方法,抽取天津市市内六区的30个街道居委会作为调查点,对每个调查点≥18岁的常住居民进行问卷调查和体格检查。结果共调查28515人,其中心肌梗死患者315人,患病率为1．1％,标化患病率为634．59／10万。心肌梗死患病率随年龄增加而上升（X^2=294．335,P〈0．005）。高血压、糖尿病、血脂异常为心肌梗死的危险因素,而水果摄人为其保护因素。结论天津市区居民心肌梗死患病率较高,应提高居民对心肌梗死危险因素的认识,做好一、二级预防。