Risk factors for myocardial infarction in women and men: insights from the INTERHEART study
Risk factors for myocardial infarction in women and men: insights from the INTERHEART study
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DOI：
10.1093/eurheartj/ehn018
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发表时间：
2008-04-01
影响因子：
39.3
通讯作者：
Yusuf, Salim
中科院分区：
文献类型：
--
作者：
Anand, Sonia S.;Islam, Shofiqul;Yusuf, Salim
冠心病（CHD）是全球男性和女性死亡的主要原因。女性患冠心病的时间比男性晚10年左右，但原因尚不清楚。本报告的目的是确定是否存在差异的危险因素分布在不同年龄段的妇女和男子之间，以帮助解释为什么妇女发展急性心肌梗死后比manifest.Methods和结果，我们使用了INTERHEART全球病例对照研究，包括27 098名参与者来自52个国家，其中6787人是妇女。女性首次急性心肌梗死的中位年龄高于男性（65岁对56岁; P < 0.0001）。9个可改变的危险因素与女性和男性的MI相关。高血压[2.95（2.66 -3.28）vs. 2.32（2.16-2.48）]、糖尿病[4.26（3.68-4.94）vs. 2.67（2.43-2.94），体力活动[0.48（0.41-0.57）vs. 0.77（0.71-0.83）]和中度饮酒[0.41（0.34-0.50）vs. 0.88（0.82-0.94）]与女性MI的相关性比男性更强。血脂异常、吸烟、腹部肥胖、高危饮食和心理社会应激因素与MI的相关性在女性和男性中相似。与老年妇女和男子相比，年轻人的风险因素关联通常更强。所有9个风险因素的人群归因风险（PAR）均超过94%，女性和男性相似（96%对93%）。男性60岁以前发生心肌梗死的可能性明显高于女性，但在调整危险因素水平后，60岁以前发生心肌梗死的概率的性别差异减少了80%以上。9个可改变的危险因素与男性和女性的急性MI显著相关，并解释了90%以上的PAR。首次MI的年龄差异在很大程度上是由于男性与女性相比，在年轻时风险因素水平较高。
Aims Coronary heart disease (CHD) is a leading cause of death among men and women globally. Women develop CHD about 10 years later than men, yet the reasons for this are unclear. The purpose of this report is to determine if differences in risk factor distributions exist between women and men across various age categories to help explain why women develop acute MI later than men.Methods and results We used the INTERHEART global case-control study including 27 098 participants from 52 countries, 6787 of whom were women. The median age of first acute MI was higher in women than men (65 vs. 56 years; P < 0.0001). Nine modifiable risk factors were associated with MI in women and men. Hypertension [2.95(2.66 -3.28) vs. 2.32(2.16-2.48)], diabetes [4.26(3.68-4.94) vs. 2.67(2.43-2.94), physical activity [0.48(0.41-0.57) vs. 0.77(0.71-0.83)], and moderate alcohol use [0.41(0.34-0.50) vs. 0.88(0.82-0.94)] were more strongly associated with MI among women than men. The association of abnormal lipids, current smoking, abdominal obesity, high risk diet, and psychosocial stress factors with MI was similar in women and men. Risk factors associations were generally stronger among younger individuals compared to older women and men. The population attributable risk (PAR) of all nine risk factors exceeded 94%, and was similar among women and men (96 vs. 93%). Men were significantly more likely to suffer a MI prior to 60 years of age than were women, however, after adjusting for levels of risk factors, the sex difference in the probability of MI cases occurring before the age of 60 years was reduced by more than 80%.Conclusion Women experience their first acute MI on average 9 years later than men. Nine modifiable risk factors are significantly associated with acute MI in both men and women and explain greater than 90% of the PAR. The difference in age of first MI is largely explained by the higher risk factor levels at younger ages in men compared to women.