Abstract
Background: Cohort studies have shown that smoking has a substantial influence on coronary heart disease mortality in young people. Population based data on non-fatal events have been sparse, however.
Objective: To study the impact of smoking on the risk of non-fatal acute myocardial infarction (MI) in young middle age people.
Methods: From 1985 to 1994 all non-fatal MI events in the age group 35–64 were registered in men and women in the WHO MONICA (multinational monitoring of trends and determinants in cardiovascular disease) project populations (18 762 events in men and 4047 in women from 32 populations from 21 countries). In the same populations and age groups 65 741 men and 66 717 women participated in the surveys of risk factors (overall response rate 72%). The relative risk of non-fatal MI for current smokers was compared with non-smokers, by sex and five year age group.
Results: The prevalence of smoking in people aged 35–39 years who experienced non-fatal MI events was 81% in men and 77% in women. It declined with increasing age to 45% in men aged 60–64 years and 36% in women, respectively. In the 35–39 years age group the relative risk of non-fatal MI for smokers was 4.9 (95% confidence interval (CI) 3.9 to 6.1) in men and 5.3 (95% CI 3.2 to 8.7) in women, and the population attributable fractions were 65% and 55%, respectively.
Conclusions: During the study period more than half of the non-fatal MIs occurring in young middle age people can be attributed to smoking.
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Selected References
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- Barbash G. I., White H. D., Modan M., Diaz R., Hampton J. R., Heikkila J., Kristinsson A., Moulopoulos S., Paolasso E. A., Van der Werf T. Acute myocardial infarction in the young--the role of smoking. The Investigators of the International Tissue Plasminogen Activator/Streptokinase Mortality Trial. Eur Heart J. 1995 Mar;16(3):313–316. [PubMed] [Google Scholar]
- Barbash G. I., White H. D., Modan M., Diaz R., Hampton J. R., Heikkila J., Kristinsson A., Moulopoulos S., Paolasso E. A., Van der Werf T. Significance of smoking in patients receiving thrombolytic therapy for acute myocardial infarction. Experience gleaned from the International Tissue Plasminogen Activator/Streptokinase Mortality Trial. Circulation. 1993 Jan;87(1):53–58. doi: 10.1161/01.cir.87.1.53. [DOI] [PubMed] [Google Scholar]
- Caralis D. G., Deligonul U., Kern M. J., Cohen J. D. Smoking is a risk factor for coronary spasm in young women. Circulation. 1992 Mar;85(3):905–909. doi: 10.1161/01.cir.85.3.905. [DOI] [PubMed] [Google Scholar]
- Celermajer D. S., Sorensen K. E., Georgakopoulos D., Bull C., Thomas O., Robinson J., Deanfield J. E. Cigarette smoking is associated with dose-related and potentially reversible impairment of endothelium-dependent dilation in healthy young adults. Circulation. 1993 Nov;88(5 Pt 1):2149–2155. doi: 10.1161/01.cir.88.5.2149. [DOI] [PubMed] [Google Scholar]
- DerSimonian R., Laird N. Meta-analysis in clinical trials. Control Clin Trials. 1986 Sep;7(3):177–188. doi: 10.1016/0197-2456(86)90046-2. [DOI] [PubMed] [Google Scholar]
- Doggen C. J., Cats V. M., Bertina R. M., Rosendaal F. R. Interaction of coagulation defects and cardiovascular risk factors: increased risk of myocardial infarction associated with factor V Leiden or prothrombin 20210A. Circulation. 1998 Mar 24;97(11):1037–1041. doi: 10.1161/01.cir.97.11.1037. [DOI] [PubMed] [Google Scholar]
- Doll R., Peto R. Mortality in relation to smoking: 20 years' observations on male British doctors. Br Med J. 1976 Dec 25;2(6051):1525–1536. doi: 10.1136/bmj.2.6051.1525. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Doll R., Peto R., Wheatley K., Gray R., Sutherland I. Mortality in relation to smoking: 40 years' observations on male British doctors. BMJ. 1994 Oct 8;309(6959):901–911. doi: 10.1136/bmj.309.6959.901. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Escobedo L. G., Caspersen C. J. Risk factors for sudden coronary death in the United States. Epidemiology. 1997 Mar;8(2):175–180. doi: 10.1097/00001648-199703000-00009. [DOI] [PubMed] [Google Scholar]
- Kuulasmaa K., Tunstall-Pedoe H., Dobson A., Fortmann S., Sans S., Tolonen H., Evans A., Ferrario M., Tuomilehto J. Estimation of contribution of changes in classic risk factors to trends in coronary-event rates across the WHO MONICA Project populations. Lancet. 2000 Feb 26;355(9205):675–687. doi: 10.1016/s0140-6736(99)11180-2. [DOI] [PubMed] [Google Scholar]
- McElduff P., Dobson A. J. Case fatality after an acute cardiac event: the effect of smoking and alcohol consumption. J Clin Epidemiol. 2001 Jan;54(1):58–67. doi: 10.1016/s0895-4356(00)00265-1. [DOI] [PubMed] [Google Scholar]
- McElduff P., Dobson A., Beaglehole R., Jackson R. Rapid reduction in coronary risk for those who quit cigarette smoking. Aust N Z J Public Health. 1998 Dec;22(7):787–791. doi: 10.1111/j.1467-842x.1998.tb01494.x. [DOI] [PubMed] [Google Scholar]
- Miettinen O. S. The "case-control" study: valid selection of subjects. J Chronic Dis. 1985;38(7):543–548. doi: 10.1016/0021-9681(85)90039-6. [DOI] [PubMed] [Google Scholar]
- Newby D. E., Wright R. A., Labinjoh C., Ludlam C. A., Fox K. A., Boon N. A., Webb D. J. Endothelial dysfunction, impaired endogenous fibrinolysis, and cigarette smoking: a mechanism for arterial thrombosis and myocardial infarction. Circulation. 1999 Mar 23;99(11):1411–1415. doi: 10.1161/01.cir.99.11.1411. [DOI] [PubMed] [Google Scholar]
- Parish S., Collins R., Peto R., Youngman L., Barton J., Jayne K., Clarke R., Appleby P., Lyon V., Cederholm-Williams S. Cigarette smoking, tar yields, and non-fatal myocardial infarction: 14,000 cases and 32,000 controls in the United Kingdom. The International Studies of Infarct Survival (ISIS) Collaborators. BMJ. 1995 Aug 19;311(7003):471–477. doi: 10.1136/bmj.311.7003.471. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Prescott E. Commentary: tobacco-related diseases: a gender differential? Int J Epidemiol. 2001 Aug;30(4):793–794. doi: 10.1093/ije/30.4.793. [DOI] [PubMed] [Google Scholar]
- Smith C. J., Fischer T. H. Particulate and vapor phase constituents of cigarette mainstream smoke and risk of myocardial infarction. Atherosclerosis. 2001 Oct;158(2):257–267. doi: 10.1016/s0021-9150(01)00570-6. [DOI] [PubMed] [Google Scholar]
- Sonke G. S., Stewart A. W., Beaglehole R., Jackson R., White H. D. Comparison of case fatality in smokers and non-smokers after acute cardiac event. BMJ. 1997 Oct 18;315(7114):992–993. doi: 10.1136/bmj.315.7114.992. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Tunstall-Pedoe H., Kuulasmaa K., Amouyel P., Arveiler D., Rajakangas A. M., Pajak A. Myocardial infarction and coronary deaths in the World Health Organization MONICA Project. Registration procedures, event rates, and case-fatality rates in 38 populations from 21 countries in four continents. Circulation. 1994 Jul;90(1):583–612. doi: 10.1161/01.cir.90.1.583. [DOI] [PubMed] [Google Scholar]
- Tunstall-Pedoe H., Kuulasmaa K., Mähönen M., Tolonen H., Ruokokoski E., Amouyel P. Contribution of trends in survival and coronary-event rates to changes in coronary heart disease mortality: 10-year results from 37 WHO MONICA project populations. Monitoring trends and determinants in cardiovascular disease. Lancet. 1999 May 8;353(9164):1547–1557. doi: 10.1016/s0140-6736(99)04021-0. [DOI] [PubMed] [Google Scholar]
- Tunstall-Pedoe H., Vanuzzo D., Hobbs M., Mähönen M., Cepaitis Z., Kuulasmaa K., Keil U. Estimation of contribution of changes in coronary care to improving survival, event rates, and coronary heart disease mortality across the WHO MONICA Project populations. Lancet. 2000 Feb 26;355(9205):688–700. doi: 10.1016/s0140-6736(99)11181-4. [DOI] [PubMed] [Google Scholar]