Table 7.
Multivariable Adjusted Rate Ratios for Smoking, Alcohol Consumption, and Physical Activity by Family History of Premature MI in the CAREMA Cohort, 1987-2003
| Acute Myocardial Infarction | Unstable Angina Pectoris | |||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| No family history (n = 15,980) | Family historya (n = 3,116) | No family history (n = 15,980) | Family history (n = 3,116) | |||||||||
| Cases/person-years | RR | 95% CI | Cases/person-years | RR | 95% CI | Cases/person-years | RR | 95% CI | Cases/person-years | RR | 95% CI | |
| Smoking statusb | ||||||||||||
| Never | 43/60,695 | 1 | reference | 14/9,971 | 1.78 | 0.96, 3.28 | 43/60,695 | 1 | reference | 12/9,971 | 1.71 | 0.89, 3.29 |
| Ex | 76/45,928 | 1.36 | 0.93, 1.98 | 17/8,710 | 2.01 | 1.14, 3.55 | 68/45,928 | 1.34 | 0.90, 1.98 | 18/8,710 | 2.50 | 1.43, 4.37 |
| Current | 212/69,412 | 3.11 | 2.22, 4.36 | 58/14,857 | 5.25 | 3.51, 7.84 | 105/69,412 | 1.63 | 1.13, 2.36 | 28/14,857 | 2.86 | 1.76, 4.64 |
| P interactionc | 0.89 | 0.97 | ||||||||||
| Alcohol consumptiond | ||||||||||||
| Never | 49/22,647 | 1 | reference | 14/4,173 | 1.71 | 0.94, 3.11 | 33/22,647 | 1 | reference | 7/4,173 | 1.44 | 0.63, 3.25 |
| Ex | 9/2,229 | 0.86 | 0.42, 1.77 | 4/448 | 2.58 | 0.92, 7.20 | 6/2,229 | 1.10 | 0.46, 2.66 | 1/448 | 1.49 | 0.20, 10.98 |
| Occasionally | 60/40,094 | 0.91 | 0.62, 1.33 | 17/8,123 | 1.42 | 0.81, 2.48 | 42/40,094 | 0.98 | 0.62, 1.56 | 15/8,123 | 2.16 | 1.16, 4.01 |
| Regular | 213/111,065 | 0.66 | 0.47, 0.92 | 54/20,794 | 1.05 | 0.70, 1.58 | 135/111,065 | 0.70 | 0.46, 1.05 | 35/20,794 | 1.21 | 0.73, 2.00 |
| P interaction | 0.79 | 0.84 | ||||||||||
| Occupational activitye | ||||||||||||
| Men | ||||||||||||
| None to light | 185/55,603 | 1 | reference | 37/9,587 | 1.47 | 1.03, 2.11 | 111/55,603 | 1 | reference | 21/9,587 | 1.49 | 0.93, 2.40 |
| Moderate to heavy | 56/18,971 | 1.23 | 0.90, 1.68 | 24/3,878 | 2.92 | 1.88, 4.54 | 30/18,971 | 1.13 | 0.74, 1.72 | 11/3,878 | 2.35 | 1.24, 4.45 |
| P interaction | 0.12 | 0.44 | ||||||||||
| Women | ||||||||||||
| None to light | 67/73,701 | 1 | reference | 15/14,758 | 1.08 | 0.61, 1.92 | 57/73,701 | 1 | reference | 18/14,758 | 1.79 | 1.04, 3.09 |
| Moderate to heavy | 2/13,319 | 0.24 | 0.06, 0.99 | 4/2,759 | 1.98 | 0.71, 5.55 | 5/13,319 | 0.72 | 0.29, 1.83 | 2/2,759 | 1.29 | 0.31, 5.36 |
| P interaction | 0.03 | 0.99 | ||||||||||
| Non-occupational activitye | ||||||||||||
| Men | ||||||||||||
| None to light | 91/25,465 | 1 | reference | 24/5,071 | 1.48 | 0.94, 2.34 | 58/25,465 | 1 | reference | 14/5,071 | 1.53 | 0.85, 2.76 |
| Moderate to heavy | 150/49,109 | 0.97 | 0.75, 1.27 | 37/8,394 | 1.86 | 1.26, 2.74 | 83/49,109 | 0.72 | 0.51, 1.03 | 18/8,394 | 1.27 | 0.74, 2.17 |
| P interaction | 0.40 | 0.73 | ||||||||||
| Women | ||||||||||||
| None to light | 28/36,894 | 1 | reference | 4/8,176 | 0.58 | 0.20, 1.70 | 20/36,894 | 1 | reference | 8/8,176 | 1.86 | 0.81, 4.30 |
| Moderate to heavy | 41/50,126 | 1.43 | 0.87, 2.38 | 15/9,340 | 2.75 | 1.45, 5.23 | 42/50,126 | 1.57 | 0.91, 2.72 | 12/9,340 | 2.75 | 1.33, 5.67 |
| P interaction | 0.06 | 0.91 | ||||||||||
CI, confidence interval; n, number; RR, rate ratio. All RRs were adjusted for age at baseline (years), baseline cohort (PPHVZ or MORGEN), level of education (primary school/junior vocational education, secondary vocational education or vocational college/university), diabetes mellitus (yes/no), total and HDL cholesterol levels (mmol/L), systolic blood pressure (mmHg), and body mass index (kg/m2).
Table summary: None of the interactions between family history of premature MI and the lifestyle factors smoking, alcohol consumption, and physical activity were statistically significant on a multiplicative scale for both AMI and UAP, except for occupational physical activity and the AMI risk in women (p interaction 0.03). Nevertheless, the highest risks of both coronary endpoints were found in subjects with both a positive family history and the most unfavorable level of the lifestyle factors.
a Positive family history was defined as at least one parent with a premature MI, i.e. age at diagnosis ≤60 years for the father and ≤65 years for the mother.
b RRs additionally adjusted for sex and alcohol consumption (glasses/day).
c P interaction refers to the significance of the interaction between the determinant and family history of premature MI on a multiplicative scale.
d RRs additionally adjusted for sex, smoking status (never, ex- or current smoker), smoking frequency (cigarettes/day), and smoking duration (years).
e RRs additionally adjusted for smoking status (never, ex- or current smoker), smoking frequency (cigarettes/day), smoking duration (years), and alcohol consumption (glasses/day). Furthermore, occupational and non-occupational physical activity were mutually adjusted.