Public health importance of triggers of myocardial infarction: a comparative risk assessment

• Published in: The Lancet (British edition) 2011, Vol.377 (9767), p.732-740
• Main Authors: Nawrot, Tim S, Dr, Perez, Laura, PhD, Künzli, Nino, Prof, Munters, Elke, MD, Nemery, Benoit, Prof
• Format: Article
• Language: English
• Subjects: Adult; Aged; Air pollution; Air Pollution - adverse effects; Alcohol; alcohols; Biological and medical sciences; Cannabis - adverse effects; Cannabis sativa; Cardiology. Vascular system; Cocaine; Cocaine - adverse effects; Coffee; Coffee - adverse effects; comparative risk assessment; Coronary heart disease; Data collection; Emotions; Environmental Exposure - adverse effects; epidemiological studies; Estimates; Female; General aspects; Heart; Heart attacks; Humans; Infection; Internal Medicine; issues and policy; Male; Medical sciences; Middle Aged; Miscellaneous; Myocardial infarction; Myocardial Infarction - epidemiology; Myocardial Infarction - etiology; Odds Ratio; Outdoor air quality; Particulate matter; Particulate Matter - adverse effects; particulates; Physical Exertion; Pollution effects; Prevalence; Public health; Public Health - statistics & numerical data; Public Health - trends; Public health. Hygiene; Public health. Hygiene-occupational medicine; Regression analysis; Respiratory Tract Infections - complications; risk; Risk Assessment; Risk Factors; Science policy; Sexual Behavior; Studies; Sustainable development; Traffic; United States - epidemiology
• ISSN: 0140-6736; 1474-547X
• DOI: 10.1016/S0140-6736(10)62296-9

Summary Background Acute myocardial infarction is triggered by various factors, such as physical exertion, stressful events, heavy meals, or increases in air pollution. However, the importance and relevance of each trigger are uncertain. We compared triggers of myocardial infarction at an individual and population level. Methods We searched PubMed and the Web of Science citation databases to identify studies of triggers of non-fatal myocardial infarction to calculate population attributable fractions (PAF). When feasible, we did a meta-regression analysis for studies of the same trigger. Findings Of the epidemiologic studies reviewed, 36 provided sufficient details to be considered. In the studied populations, the exposure prevalence for triggers in the relevant control time window ranged from 0·04% for cocaine use to 100% for air pollution. The reported odds ratios (OR) ranged from 1·05 to 23·7. Ranking triggers from the highest to the lowest OR resulted in the following order: use of cocaine, heavy meal, smoking of marijuana, negative emotions, physical exertion, positive emotions, anger, sexual activity, traffic exposure, respiratory infections, coffee consumption, air pollution (based on a difference of 30 μg/m3 in particulate matter with a diameter