Document Detail

Public health importance of triggers of myocardial infarction: a comparative risk assessment.
MedLine Citation:
PMID:  21353301     Owner:  NLM     Status:  MEDLINE    
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 <10 μm [PM10]). Taking into account the OR and the prevalences of exposure, the highest PAF was estimated for traffic exposure (7.4%), followed by physical exertion (6.2%), alcohol (5.0%), coffee (5.0%), a difference of 30 μg/m3 in PM10 (4.8%), negative emotions (3.9%), anger (3.1%), heavy meal (2.7%), positive emotions (2.4%), sexual activity (2.2%), cocaine use (0.9%), marijuana smoking (0.8%) and respiratory infections (0.6%). Interpretation In view of both the magnitude of the risk and the prevalence in the population, air pollution is an important trigger of myocardial infarction, it is of similar magnitude (PAF 5-7%) as other well accepted triggers such as physical exertion, alcohol, and coffee. Our work shows that ever-present small risks might have considerable public health relevance.
FUNDING: The research on air pollution and health at Hasselt University is supported by a grant from the Flemish Scientific Fund (FWO, Krediet aan navorsers/G.0873.11), tUL-impulse financing, and bijzonder onderzoeksfonds (BOF) and at the Katholieke Universiteit Leuven by the sustainable development programme of BELSPO (Belgian Science Policy).
Tim S Nawrot; Laura Perez; Nino Künzli; Elke Munters; Benoit Nemery
Publication Detail:
Type:  Comparative Study; Journal Article; Meta-Analysis; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Lancet     Volume:  377     ISSN:  1474-547X     ISO Abbreviation:  Lancet     Publication Date:  2011 Feb 
Date Detail:
Created Date:  2011-03-03     Completed Date:  2011-04-04     Revised Date:  2011-06-27    
Medline Journal Info:
Nlm Unique ID:  2985213R     Medline TA:  Lancet     Country:  England    
Other Details:
Languages:  eng     Pagination:  732-40     Citation Subset:  AIM; IM    
Centre for Environmental Sciences, Hasselt University, Diepenbeek, Belgium.
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MeSH Terms
Air Pollution / adverse effects*
Cannabis / adverse effects
Cocaine / adverse effects
Coffee / adverse effects
Environmental Exposure / adverse effects*
Middle Aged
Myocardial Infarction / epidemiology*,  etiology*
Odds Ratio
Particulate Matter / adverse effects*
Physical Exertion
Public Health / statistics & numerical data*,  trends
Respiratory Tract Infections / complications
Risk Assessment
Risk Factors
Sexual Behavior
United States / epidemiology
Reg. No./Substance:
0/Coffee; 0/Particulate Matter; 50-36-2/Cocaine
Comment In:
Lancet. 2011 Jun 25;377(9784):2175; author reply 2175-6   [PMID:  21704859 ]
Lancet. 2011 Jun 25;377(9784):2175; author reply 2175-6   [PMID:  21704860 ]
Lancet. 2011 Feb 26;377(9767):694-6   [PMID:  21353302 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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