A prospective study of obesity and risk of coronary heart disease in women

We examined the incidence of nonfatal and fatal coronary heart disease in relation to obesity in a prospective cohort study of 115,886 U.S. women who were 30 to 55 years of age in 1976 and free of diagnosed coronary disease, stroke, and cancer. During eight years of follow-up (775,430 person-years), we identified 605 first coronary events, including 306 nonfatal myocardial infarctions, 83 deaths due to coronary heart disease, and 216 cases of confirmed angina pectoris. A higher Quetelet index (weight in kilograms divided by the square of the height in meters) was positively associated with the occurrence of each category of coronary heart disease. For increasing levels of current Quetelet index (less than 21, 21 to less than 23, 23 to less than 25, 25 to less than 29, and greater than or equal to 29), the relative risks of nonfatal myocardial infarction and fatal coronary heart disease combined, as adjusted for age and cigarette smoking, were 1.0, 1.3, 1.3, 1.8, and 3.3 (Mantel-extension chi for trend = 7.29; P less than 0.00001). As expected, control for a history of hypertension, diabetes mellitus, and hypercholesterolemia--conditions known to be biologic effects of obesity--attenuated the strength of the association. The current Quetelet index was a more important determinant of coronary risk than that at the age of 18; an intervening weight gain increased risk substantially. These prospective data emphasize the importance of obesity as a determinant of coronary heart disease in women. After control for cigarette smoking, which is essential to assess the true effects of obesity, even mild-to-moderate overweight increased the risk of coronary disease in middle-aged women.     

Relative and absolute excess risks of coronary heart disease among women who smoke cigarettes

We prospectively examined the incidence of coronary heart disease in relation to cigarette smoking in a cohort of 119,404 female nurses who were 30 to 55 years of age in 1976 and were free of diagnosed coronary disease. During six years of follow-up, 65 of the women died of fatal coronary heart disease and 242 had a nonfatal myocardial infarction. The number of cigarettes smoked per day was positively associated with the risk of fatal coronary heart disease (relative risk = 5.5 for greater than or equal to 25 cigarettes per day), nonfatal myocardial infarction (relative risk = 5.8), and angina pectoris (relative risk = 2.6). Even smoking 1 to 4 or 5 to 14 cigarettes per day was associated with a twofold to three-fold increase in the risk of fatal coronary heart disease or nonfatal infarction. Overall, cigarette smoking accounted for approximately half these events. The attributable (absolute excess) risk of coronary heart disease due to current smoking was highest among women who were already at increased risk because of older age, a parental history of myocardial infarction, a higher relative weight, hypertension, hypercholesterolemia, or diabetes. In contrast, former smokers had little, if any, increase in risk. These prospective data emphasize the importance of cigarette smoking as a determinant of coronary heart disease in women, as well as the markedly increased hazards associated with this habit in combination with other risk factors for this disease.     

同型半胱氨酸与老年人心脑血管病变关系的研究

目的　比较血清同型半胱氨酸 (HCY)、叶酸、维生素B12 等与原发性高血压、冠心病、脑卒中病变的关系 ,探讨其血浓度在预测老年人心、脑血管病变中的意义 .方法　对 2 2 4例患原发性高血压、冠心病、脑卒中患者和 10 6例健康体检正常的对照组应用荧光偏振法 (FPIA)分析血清HCY和用微粒子酶免疫分析 (MEIA)测定血清叶酸、VitB12 水平并比较各组间差异 .结果　心肌梗死组、脑溢血和脑梗死患者的血清HCY水平显著高于正常对照组 (p <0 .0 1) ,而叶酸浓度则明显低于正常对照组 (p<0 .0 1) .VitB12 含量仅在脑梗死组中低于正常对照组 .单纯原发性高血压组和心绞痛组的血清HCY和叶酸的含量与正常对照组比较无差异 .在冠心病、脑卒患者中血清HCY浓度与血清叶酸浓度呈负相关 (r=- 0 .6 0 8,p<0 .0 1;r=- 0 .6 87,p<0 .0 1) .结论　在老年人群中血清HCY浓度增高与低叶酸水平是冠心病、脑血管疾病的一个重要危险因素 .用荧光偏振 (FPIA)法检测血清HCY浓度可作为评价和预测心、脑血管疾病的一个敏感可信的指标     

Risk stratification by treadmill testing in acute myocardial infarction following thrombolytic therapy

Survivors of acute myocardial infarction (AMI) should have risk stratification for assessment of their future risk of cardiovascular events. One of the important means of risk stratification is by treadmill test (TMT). Most of the algorithms for assessment were done in the prethrombolytic era. But in the post-thrombolytic era, risk stratification by TMT should be properly evaluated. Fifty males with confirmed AMI with age ranging from 38-62 years (mean 48 years) were tested with a symptom limited (Modified Bruce Protocol) TMT. The patients were followed up for a minimum of 6 months (range 6-10 months). Out of 50 patients, 38 reported for follow up. Among them 22 (Group A) had cardiac events and 16 (Group B) had no events. Among the patients (Group A), 6 had unstable angina, 7 had reinfarction, 2 had sudden death, 4 had coronary artery bypass grafting (CABG) and 3 had angioplasty. Comparison between the two groups, A and B in TMT parameters like ST segment depression > 2.5 mm (12 vs 9), no. of leads where ST depression occurred (66 vs 48) during exercise, mean work capacity (8.1 vs 7.9 mets), mean systolic blood pressure response were all statistically insignificant. Though TMT was believed to be a good prognostic indicator to assess further cardiac events after AMI, its efficacy in risk stratification after thrombolysis is yet to be determined. This study does not show its worth in post MI risk assessment.     

A prospective study of walking as compared with vigorous exercise in the prevention of coronary heart disease in women.

BACKGROUND: The role of walking, as compared with vigorous exercise, in the prevention of coronary heart disease remains controversial, and data for women on this topic are sparse. METHODS: We prospectively examined the associations between the score for total physical activity, walking, and vigorous exercise and the incidence of coronary events among 72,488 female nurses who were 40 to 65 years old in 1986. Participants were free of diagnosed cardiovascular disease or cancer at the time of entry and completed serial detailed questionnaires about physical activity. During eight years of follow-up, we documented 645 incident coronary events (nonfatal myocardial infarction or death from coronary disease). RESULTS: There was a strong, graded inverse association between physical activity and the risk of coronary events. As compared with women in the lowest quintile group for energy expenditure (expressed as the metabolic-equivalent [MET] score), women in increasing quintile groups had age-adjusted relative risks of 0.77, 0.65, 0.54, and 0.46 for coronary events (P for trend <0.001). In multivariate analyses, the inverse gradient remained strong (relative risks, 0.88, 0.81, 0.74, and 0.66 for women in increasing quintile groups as compared with those in the lowest quintile group; P for trend=0.002). Walking was inversely associated with the risk of coronary events; women in the highest quintile group for walking, who walked the equivalent of three or more hours per week at a brisk pace, had a multivariate relative risk of 0.65 (95 percent confidence interval, 0.47 to 0.91) as compared with women who walked infrequently. Regular vigorous exercise (> or =6 MET) was associated with similar risk reductions (30 to 40 percent). Sedentary women who became active in middle adulthood or later had a lower risk of coronary events than their counterparts who remained sedentary. CONCLUSIONS: These prospective data indicate that brisk walking and vigorous exercise are associated with substantial and similar reductions in the incidence of coronary events among women.     

Cardiotoxicities of paclitaxel in African Americans

PURPOSE: To assess the cardiac disturbances in African-American patients treated with paclitaxel. PATIENTS AND METHODS: One-hundred-nineteen African-American patients received paclitaxel for various cancers at Howard University Hospital during the years 1993-2001. Medical records of 100 patients were available for review. Sixty-seven percent were women and 33% were men. Ages ranged between 26-85 years (mean age 51 years). Medical records were reviewed for demographics, types of cancer, dosage and frequency of paclitaxel and other chemotherapeutic agents, events during paclitaxel infusion, initial and subsequent EKGs, and hospital admissions. We used the Chi-square test to compare EKG changes in patients with and without cardiac risk factors. RESULTS: Ninety patients received paclitaxel as second-line chemotherapy, and 10 patients were treated with paclitaxel as a single agent. Dosage of paclitaxel ranged from 75-200 mg/square meter and was administered every 1-3 weeks. The electrocardiogram readings revealed the following cardiac events: 26% sinus tachycardia, 13% non-specific T-wave changes, 6% myocardial infarction, 4% prolonged QT interval, 4% left-bundle branch block, 3% right-bundle branch block, 3% sinus bradycardia, 2% premature atrial contractions, 2% premature ventricular contractions, 2% atrial flutter, and 1% atrial fibrillation. Eighty percent of the patients had risk factors for coronary artery disease. These cardiac disturbances were observed from day one to a maximum of eight years after receiving the chemotherapy and were independent of dosage of paclitaxel. Sixty percent of our study population had underlying co-morbid conditions, such as dehydration, anemia, sepsis, and hypoxia. The EKG changes observed in patients with underlying cardiac risk factors were statistically significant (p<0.0001). CONCLUSION: Paclitaxel was not associated with significant symptomatic cardiac disturbances during infusion in our study population. Caution should be exercised in patients with underlying cardiac disease and risk factors for coronary artery disease. However more prospective studies with closer follow-up during paclitaxel infusion are needed to assess its cardiotoxicities.     

Pathological evaluation of coronary lesions in cases of cardiac rupture during acute myocardial infarction: An autopsy study of 148 out-of-hospital sudden death cases

We pathologically evaluated coronary artery lesions of left ventricular ruptures during acute myocardial infarctions (148 sudden out-of-hospital death cases; 93 men and 55 women; age range 42–94 years; mean age 68.9 years; 143 atherosclerotic and 5 non-atherosclerotic lesions). Among the 143 hearts with atherosclerotic coronary lesions, three-vessel disease was most frequent, and plaque rupture or erosion and occlusive thrombus were identified in most cases. Ages of the main component of the occlusive thrombus in the culprit coronary artery corresponded histopathologically to those of myocardial infarction. One of the most outstanding features in this pathological study is that acute thrombus in the culprit coronary artery was identified morphologically in most of the cases with advanced myocardial infarction (3 or more days). On the other hand, in cases of fresh myocardial infarction, a preceding mural non-occlusive organizing thrombus was observed mostly underneath the main component of the thrombus. It is suggested that, in most cases, cardiac rupture during acute myocardial infarction occurs at the time of a new ischemic event caused by a new thrombotic coronary lesion.     

Lung function and risk of myocardial infarction and sudden cardiac death.

In a serach for risk factors for myocardial infarction and sudden cardiac death, the mean total vital capacity as measured at multiphasic health checkups was lower in persons who later had a first myocardial infarction than in risk-factor-matched controls (3.17 vs. 3.29 liters, 395 pairs, P less than 0.05) and non-risk-factor-matched controls (3.16 vs. 3.41 liters, 401 pairs, P less than 0.001). Findings were little affected by age and height adjustment and were similar for sudden cardiac death. The first-second vital capacity was also inversely related to later development of these conditions, but the ratio of that measurement to total vital capacity was not. Heavy smoking, productive cough, exertional dyspnea and cardiac enlargement were associated with diminished total capacity. However, exclusion of subjects with these findings did not reduce the predictive value of total vital capacity. Diminished vital capacity deserves continued attention as a possible coronary risk factor. Its relation to subsequent coronary events is not well explained.     

Apolipoprotein A and prognosis after myocardial infarction in non-diabetic men

Summary The implications of apolipoproteins A-I and A-II for the prognosis of 178 non-diabetic men after acute myocardial infarction were studied. During a mean follow-up period of 4 years, one or more coronary events (nonfatal myocardial infarction, fatal coronary heart disease, coronary artery bypass graft surgery, deterioration of exercise ECG) were recorded in 37 patients. Serum levels of apolipoproteins A-I and A-II did not discriminate between patients with and without coronary events. This applied to the entire sample as much as to subgroups defined by presence or absence of interventions (coronary artery bypass graft surgery, long-term therapy with beta-blockers or lipid-lowering drugs). We conclude that coronary events in the first years after myocardial infarction cannot be predicted by apolipoprotein A-I or A-II levels.Abbreviations HDL High density lipoprotein - LDL Low density lipoprotein Supported by Ludwig-Boltzmann-Gesellschaft     

Prognostic importance of thallium uptake by the lungs during exercise in coronary artery disease

We studied the value of thallium imaging as compared with clinical and exercise-test variables in predicting cardiac events occurring over five years in 525 consecutive patients referred for thallium-exercise testing in 1979. Follow-up was obtained on 467 patients (89 percent). There were 105 cardiac events--25 cardiac deaths, 33 myocardial infarctions, and 47 coronary bypass procedures. A Cox survival analysis identified increased thallium uptake by the lungs, a marker of left ventricular dysfunction during exercise, as the best predictor of a cardiac event (relative risk ratio = 3.5; 95 percent confidence interval, 2.2 to 5.4). The next most powerful predictors were a history of typical angina, a previous myocardial infarction, and ST-segment depression during exercise (relative risk ratios = 2.1, 1.8, and 1.7, respectively). No combination of variables made up for the loss in prognostic power when the variable of increased thallium uptake by the lungs was removed from the model. Cardiac events occurred over five years in 10 (5 percent) of 192 patients with a normal thallium scan, 41 (25 percent) of 163 patients with an abnormal thallium scan but normal thallium activity in the lungs, and 54 (67 percent) of 81 patients with increased thallium uptake by the lungs (P less than 0.0001). We conclude that increased uptake of thallium by the lungs during exercise predicts a high risk of subsequent cardiac events.     

30岁以下急性ST段抬高型心肌梗死患者临床特点分析

目的 探讨30岁以下急性ST段抬高型心肌梗死患者的临床特点。方法 选择首次发病的STEMI患者51例,按年龄分青年组17例（年龄18～30岁）,对照组34例（年龄≥31岁）,对两组人群常见的危险因素、临床特点、冠状动脉病变特点以及发病30 d内主要不良心血管事件发生率进行对比分析。结果 ①青年组中男性、吸烟、合并高血压、合并高脂血症患者比例明显高于对照组,差异有统计学意义（P＜0.05）;青年组体质量指数、左心室射血分数以及血清总胆固醇、甘油三酯、低密度脂蛋白胆固醇水平明显高于对照组,总胆红素水平低于对照组,差异有统计学意义（P＜0.05）;②青年组“罪犯血管”病变类型以单支病变、A型病变为主,对照组多为三支病变、分叉病变、C型病变,差异有统计学意义（P＜0.05）;③青年组发病30 d内梗死后心绞痛、心力衰竭、恶性心律失常的发生率明显低于对照组,差异有统计学意义（P＜0.05）。结论 男性、吸烟、合并高血压、合并高脂血症是30岁以下STEMI患者突出的危险因素,其冠脉病变多为单支、A型病变,发病30 d内临床预后良好。     

Coronary atherosclerosis, coronary thrombosis and myocardial infarction in autopsy cases. 8th communication: Relationship of coronary atherosclerosis and myocardial infarction (author's transl)

The autopsy reports of the Pathological Institute Erfurt of the period from 1.1.1951 until 31.12.1969 were scored for cases of coronary atherosclerosis and myocardial infarction and analysed concerning frequency and distribution of age and sex, resp. In 89.05 per cent (2131 cases) of all myocardial infarctions a coronary sclerosis was present. Males suffered significantly more frequent from these forms of ischaemic heart disease. During the period of nineteen years a significant increase of the coronary atherosclerosis in combination with a myocardial infarction was observed. This is due to the more frequent occurrence of severe forms. The increase of the frequency of the myocardial infarctions and of the weak and moderately coronary sclerosis particularly concerns the younger age groups. Callous infarcts were more frequent than fresh and relapsing ones.     

Association between hormonal changes at menopause and the risk of a coronary event: a longitudinal study

OBJECTIVE: To investigate the association of hormone levels at menopause, lifestyle variables, and body composition with the predicted 10-year risk of a coronary event, calculated using the PROCAM scoring system, in a population-based sample of Australian-born, middle-aged women. DESIGN: A 9-year prospective study of 438 Australian-born women, who at baseline were aged 45 to 55 years and had menstruated in the prior 3 months. Interviews, fasting blood, and physical measurements were taken annually. The risk of an acute coronary event was calculated using the PROCAM scoring system (includes: age, low-density lipoprotein cholesterol, smoking, high-density lipoprotein cholesterol, systolic blood pressure, family history of premature myocardial infarction, diabetes mellitus, and triglycerides). RESULTS: Retention rate after 8 years of follow-up was 88% (n = 387). In women not using hormone therapy (HT): higher than average body mass index (BMI) (P < 0.001), BMI that increased (P < 0.005), lower than average estradiol levels (P < 0.005), estradiol levels that decreased (P < 0.001), and high free testosterone levels (P < 0.05) were associated with increased risk of a coronary event. There was a trend for high exercise frequency to be associated with a decreased risk (P < 0.07). After BMI and lifestyle variables were taken into account, use of HT did not have a significant effect on risk of a coronary event. CONCLUSION: In this longitudinal observational study of middle-aged Australian-born women, high BMI, an increase in BMI, high free testosterone, low estradiol, and a decrease in estradiol levels were the main determinants of increased risk of an acute coronary event, based on the PROCAM scoring system calculation. More frequent exercise tended to lower the risk.     

国产雷帕霉素药物涂层支架置入ST抬高型心肌梗死患者的近期预后

背景：冠状动脉药物涂层支架置入治疗是急性ST段抬高型心肌梗死的最佳治疗方法,但由于老年患者合并危险因素较多,死亡率随着年龄的增加而增高。 目的：观察不同年龄ST段抬高型心肌梗死患者置入国产雷帕霉素药物涂层支架的临床特征及住院期间预后特点。 方法：回顾性分析307例因初发ST段抬高型心肌梗死接受急诊冠状动脉国产雷帕霉素药物涂层支架置入治疗患者的临床资料,根据年龄分为3组,非老年组(< 65岁,n=175)、普通老年组(65-74岁,n=83)、高龄组(≥75岁,n=49),比较3组住院期间的临床特征、病死率及联合心血管事件发生情况。 结果与结论：与非老年组相比,普通老年组、高龄组女性比例较高(P < 0.05),吸烟者较少(P < 0.05),既往高血压病史比例增加(P < 0.05),血红蛋白、总胆固醇、三酰甘油、低密度脂蛋白胆固醇水平降低(P < 0.05)。随着年龄的增长,血清肌酐水平逐渐升高,恶性心律失常发生率与住院期间心源性死亡发生率逐渐增加。与非老年组、普通老年组比较,高龄组心功能Killip分级≥Ⅱ级比例、3支或左主干病变比例较高(P < 0.05),成功再灌注率下降(P < 0.05),急性充血性心力衰竭、联合心血管事件的发生率较高(P < 0.05)。多因素Logistic回归分析显示,年龄是患者住院期间病死率的独立危险因素(P < 0.01)。中国组织工程研究杂志出版内容重点：生物材料;骨生物材料; 口腔生物材料; 纳米材料; 缓释材料; 材料相容性;组织工程全文链接：     

Platelet hyperreactivity and prognosis in survivors of myocardial infarction

We tested the hypothesis that an increase in spontaneous aggregability of platelets in vitro predicts mortality and coronary events in patients who have survived a recent myocardial infarction. A cohort of 149 survivors of infarction entered our study three months after the index infarction and was followed for five years. At entry and at intervals of six months, spontaneous platelet aggregation (SPA) was tested and graded as positive (aggregation within 10 minutes), intermediate (aggregation after 10 to 20 minutes), or negative (no aggregation within 20 minutes). During follow-up, 6.4 percent (6 of 94) of the patients in the SPA-negative group died, as compared with 10.3 percent (3 of 29) in the SPA-intermediate group and 34.6 percent (9 of 26) in the SPA-positive group. As compared with the SPA-negative group, the SPA-intermediate group had a relative risk of death of 1.6 (95 percent confidence interval, 0.5 to 5.5) and the SPA-positive group had a risk of 5.4 (95 percent confidence interval, 2.2 to 13.4). At least one cardiac event (cardiac death or recurrent nonfatal myocardial infarction) occurred in 14.9 percent (14 of 94 patients) of the SPA-negative group, 24.1 percent (7 of 29) of the SPA-intermediate group, and 46.2 percent (12 of 26) of the SPA-positive group. A positive test result continued to have prognostic value throughout the five-year study. We conclude that spontaneous platelet aggregation in vitro is a useful biologic marker for the prediction of coronary events and mortality in this low-risk group of survivors of a myocardial infarction. A causal relation is suggested but not proved by our study.     

Anxiety,depression, and heart disease in women

This is an extension of previous research that has reported on psychosocial risk factors in women participants in the Recurrent Coronary Prevention Project (RCPP). The RCPP women (N = 83) were under 65 years of age, non-diabetic, non-smoking and had experienced a myocardial infarction (MI) at least 6 months prior to the study. Baseline data was available on 80 RCPP subjects. Seventy three non-smoking, coronary disease-free women participants in the Stanford-Sunnyvale Health Improvement Project (SSHIP) served as a control-comparison group. Women with coronary heart disease had higher serum cholesterol than controls. There were no case-control differences in marital status, occupation, or number of children. RCPP women had Videotaped Structured Interview (VSI) Type A scores comparable to those of the SSHIP women, but had significantly higher VSI-hostility scores (p < .01). In addition. the post-MI women were rated more anxious and depressed, and had more avoidance symptoms than controls ( p < .01). Additional analyses involved the 65 RCPP women located at 8.5-year follow-up. In these women, univariate predictors of coronary recurrence (N = 13) were body mass index (kg/m)2. Peel Index, low time urgency (VSI) and high anxiety ( p < .05). Employment status, marital status, and education were not associated with subsequent cardiac events. These exploratory analyses suggest that the relations between heart disease and hostility, anxiety, and depression in women deserve further investigation.     

Nicotine and carbon monoxide content of cigarette smoke and the risk of myocardial infarction in young men

To evaluate whether the nicotine and carbon monoxide content of cigarette smoke is related to the risk of nonfatal first myocardial infarction in young men, we compared 502 cases with 835 hospital controls, all between the ages of 30 and 54 years. As expected, the estimated risk of myocardial infarction increased with the number of cigarettes smoked; overall, the relative-risk estimate for current smokers was 2.8 (95 per cent confidence interval, 2.0 to 4.0). The risk did not appear to vary according to the amount of nicotine or carbon monoxide in the cigarette, and the mean amounts of both substances per cigarette were similar for the cases and controls. The results suggest that men who smoke the newer cigarettes with reduced amounts of nicotine and carbon monoxide do not have a lower risk of myocardial infarction than those who smoke cigarettes containing larger amounts of these substances.     

Postinfarction rupture of the left ventricular free wall: clinicopathologic correlates in 100 consecutive autopsy cases

Among 100 consecutive autopsied cases of postinfarction rupture of the left ventricular free wall, 51% of the deaths were in-hospital and 49% were out of hospital. There were 51 men (mean age, 72 years) and 49 women (mean age, 76 years); 81% had multivessel disease. All had severe obstruction of at least one major epicardial coronary artery (98 atherosclerotic, one thrombotic, and one embolic). Acute coronary thrombosis was present in 73 cases and occurred on an atherosclerotic plaque in 72, 49 (68%) of which had associated plaque rupture. In 83 cases, the ruptured infarction represented the subject's first myocardial infarction. Despite a history of hypertension in 55 cases, appreciable left ventricular hypertrophy was observed in only 19 cases. By histopathologic age of infarction, 13 ruptures occurred during the first day, 45 between days 2 and 5, and 22 on days 6 and 7; thus, 58% occurred within 5 days and 80% within 7 days. The mid-ventricle was the most frequent site of rupture (66%). Ruptures most frequently involved the lateral aspect of the left ventricular free wall (44%). In 66 cases, the rupture tract occurred along the interface between viable and necrotic myocardium. Our findings support the observations of others that the risk factors for postinfarction left ventricular free wall rupture include age greater than 60 years, female gender, preexisting hypertension, absence of left ventricular hypertrophy, first myocardial infarction, and midventricular or lateral wall transmural infarctions.     

Menopause and myocardial infarction risk among employed women in relation to work and family psychosocial factors in Lithuania

Objectives

To assess the relationship between menopause and age at menopause and the risk of the first non-fatal myocardial infarction taking into account the possible influence of psychosocial job characteristics, marital stress, level of social support, educational level, occupation, age and traditional ischemic heart disease risk factors.

Methods

Population-based case–control study among 35–61 years old employed women in Kaunas, Lithuania. Totally 122 myocardial infarction cases and 371 controls were interviewed in 2001–2004. The logistic regression analysis was performed.

Results

Younger age at menopause (≤40 years) showed a tendency for increased myocardial infarction risk (OR = 1.78; 95% CI 0.39–8.07) after adjustments for age, smoking, arterial blood pressure and body mass index. However further adjustment for job demands, job control, social support, marital stress, education level, occupation decreased the risk (OR = 1.16; 95% CI 0.27–5.01). In the fully adjusted model OR for postmenopausal women was 1.15; 95% CI 0.48–2.75. The association between low job control and myocardial infarction showed step increase, women in the lowest quartile of job control had the highest myocardial infarction risk (OR = 4.51; 95% CI 1.90–10.75), while those in the second and third quartiles showed modest risk. Marital stress was an independent myocardial infarction risk factor for employed women (adjusted OR = 2.36; 95% CI 1.07–5.19).

Conclusions

Menopausal status and younger age at menopause showed only a tendency for increase in myocardial infarction risk among the employed women in Kaunas, Lithuania. Adverse psychosocial job characteristics as low job control, as well as marital stress play more important role in the development of the first myocardial infarction.     

Homozygosity for the Ala allele of the PPARγ2 Pro12Ala polymorphism is associated with reduced risk of coronary artery disease

Several studies suggest that the peroxisome proliferator-activated receptor gamma (PPARγ) is involved in atherogenesis. The Pro12Ala polymorphism in the gene encoding PPARγ (PPARγ2 gene) influences the risk for type 2 diabetes. Two population-based studies have shown that the Ala allele is associated with reduced carotid intimal-medial thickness (IMT). However, studies focusing on acute clinical events have yielded conflicting results. Our aim was to evaluate the role of the Pro12Ala PPARγ2 polymorphism on the risk of coronary artery disease (CAD) in an Italian population with a case-controlled genetic association study in which 478 CAD patients and 218 controls were genotyped for the Pro12Ala polymorphism. CAD was diagnosed by angiography. We found that homozygotes for the Ala12 allele had a significantly reduced risk of CAD after adjusting for diabetes, sex, age, body mass index (BMI), smoking, lipids and hypertension (OR =0.007; 95% C.I. = 0.00-0.32 p< 0.011). In this case-control study, homozygosity for the Ala allele at codon 12 of the PPARγ2 gene resulted in reduced risk of CAD. This is consistent with reports from previous studies focusing on atherosclerosis and myocardial infarction.