Incidence of myocardial infarction in women. A cohort study of risk factors and modifiers of effect

doi:10.1136/jech.54.2.104

Journal of Epidemiology and Community Health 2000;54:104-107; doi:10.1136/jech.54.2.104

J Epidemiol Community Health 2000;54:104-107 ( February )

Research report

Incidence of myocardial infarction in women. A cohort study of risk factors and modifiers of effect G Engström^a, P Tydén^a, G Berglund^b, O Hansen^b, B Hedblad^a, L Janzon^a

^a Department of Community Medicine, Malmö University Hospital, Malmö, Sweden, ^b Department of Medicine, Malmö University Hospital

Correspondence to: Dr G Engström, Department of Community Medicine, Malmö University Hospital, ing 59, S-20502 Malmö, Sweden

Accepted for publication 5 June 1999

STUDY OBJECTIVE $---$ To assess whether the increased incidence of myocardial infarction and death associated with smoking, hypertension, hyperlipidaemiaand diabetes varies significantly between groups defined in termsof occupation, education and maritalstatus.
SETTING $---$ Malmö,Sweden.
PARTICIPANTS $---$ 9351 women, aged 28-55, with a mean follow up of 10.7years.
MAIN RESULTS $---$ Smoking, hypertension ( $>=$ 160/95 mm Hg or treatment), hyperlipidaemia (cholesterol $>=$ 6.5 mmol/l or triglycerides $>=$ 2.3 mmol/l),diabetes, low occupation and education levels were significantlymore common among women who experienced a fatal or non-fatal myocardialinfarction during the follow up (n=104) than in other women (n=9247).Exposure to smoking, hypertension and hyperlipidaemia showed substantialdifferences between groups defined in terms of education, occupationand marital status. The association between low occupation andmyocardial infarction remained statistically significant afteradjustments for several potential confounders (RR=2.6, 95%CI 1.1,6.0). Single women had similarly higher adjusted mortality ratesthan married women (RR=1.4, 95%CI 1.1, 1.8). When other majorrisk factors were taken into account, the relative risk for mortalityand myocardial infarction associated with smoking was 2.6 (95%CI2.0, 3.4) and 7.8 (95%CI 4.4, 13.9),respectively.
CONCLUSION $---$ In this urban female population, short education and low occupation level were both associated with an increased prevalenceof smoking, hypertension, hyperlipidaemia and diabetes. Low occupationlevel increases the rate of cardiac events caused by exposureto these four riskfactors.

Keywords: cardiovascular risk; myocardial infarction; education; occupation; marital status

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