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November 25, 1983, Vol 250, No. 20 >
ARTICLE | November 25, 1983

Myocardial Infarction in Women Under 50 Years of Age FREE

Lynn Rosenberg, ScD; Donald R. Miller, MS; David W. Kaufman, ScD; Susan P. Helmrich, MS; Stephen Van de Carr, MD; Paul D. Stolley, MD; Samuel Shapiro, MB, FRCP(E)
[+] Author Affiliations

Reprint requests to Drug Epidemiology Unit, School of Public Health, Boston University School of Medicine, 777 Concord Ave, Cambridge, MA 02138 (Dr Rosenberg).


JAMA. 1983;250(20):2801-2806. doi:10.1001/jama.1983.03340200035025
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References

Risk factors for first nonfatal myocardial infarction (MI) in women younger than age 50 years were evaluated in a case-control study of 255 women with MI and 802 controls. The relative risk of MI increased with the amount smoked. The estimated risk of MI for current smokers of 35 or more cigarettes per day was ten times that of women who never smoked; an estimated 65% of MIs were attributable to cigarette smoking. The relative risk of MI increased markedly with increasing levels of total plasma cholesterol and decreasing levels of high-density lipoproteins, and the effects of the two factors appeared to be independent. Other factors significantly associated with MI were hypertension, angina pectoris, diabetes mellitus, blood group A, and a history of MI or stroke before age 60 years in a mother or sibling. Factors not significantly associated with MI were obesity, history of preeclamptic toxemia, and type A personality. Women who were postmenopausal appeared to have a lower risk of MI than premenopausal women of similar ages. Of the identified risk factors, the most prominent was cigarette smoking, a habit that is amenable to change.

(JAMA 1983;250:2801-2806)

REFERENCES

1 +
 The Pooling Project Research Group: Relationship of blood pressure, serum cholesterol, smoking habit, relative weight and ECG abnormalities to incidence of major coronary events: Final report of the Pooling Project . J Chronic Dis 1978;;31:201-306.
2 +
Slone D, Shapiro S, Rosenberg L, et al:  Relation of cigarette smoking to myocardial infarction in young women . N Engl J Med 1978;;298:1273-1276.
3 +
Rosenberg L, Shapiro S, Kaufman DW, et al:  Cigarette smoking in relation to the risk of myocardial infarction in young women: Modifying influence of age and predisposing factors . Int J Epidemiol 1980;;9:57-63.
4 +
Doll R, Peto R:  Mortality in relation to smoking: Twenty years' observation on male British doctors . Br Med J 1976;;2:1525-1536.
5 +
Shapiro S, Slone D, Rosenberg L, et al:  Oral contraceptive use in relation to myocardial infarction . Lancet 1979;;1:743-746.
6 +
Slone D, Kaufman DW, Shapiro S, et al:  Risk of myocardial infarction in relation to current and discontinued oral contraceptive use . N Engl J Med 1981;;305:420-424.
7 +
Rosenberg L, Slone D, Shapiro S, et al:  Noncontraceptive estrogens and myocardial infarction in young women . JAMA 1980;;244:339-342.
8 +
Rosenberg L, Slone D, Shapiro S, et al:  Aspirin and myocardial infarction in young women . Am J Public Health 1982;;72:389-391.
9 +
Rosenberg L, Slone D, Shapiro S, et al:  Coffee drinking and myocardial infarction in younger women . Am J Epidemiol 1980;;111:675-681.
10 +
Rosenberg L, Slone D, Shapiro S, et al:  Alcoholic beverages and myocardial infarction in young women . Am J Public Health 1981;; 71:82-84.
11 +
Ischaemic Heart Disease Registers: Report of the Fifth Working Group . Copenhagen, World Health Organization, 1971;.
12 +
Manual of Laboratory Operations: Lipid Research Clinics Program, US Dept of Health, Education, and Welfare publication (NIH) 75-628. Government Printing Office, 1974.
13 +
Haynes SC, Levine S, Scotch N, et al:  The relationship of psychosocial factors to coronary heart disease in the Framingham Study: I. Methods and risk factors . Am J Epidemiol 1978;;107:362-383.
14 +
Miettinen OS:  Estimability and estimation in case-referent studies . Am J Epidemiol 1976;; 103:226-235.
15 +
Mantel N, Haenszel W:  Statistical aspects of the analysis of data from retrospective studies of disease . JNCI 1959;;22:719-748.
16 +
Armitage P: Statistical Methods in Medical Research . New York, John Wiley & Sons Inc, 1979;, pp 319-320.
17 +
Miettinen OS:  Proportion of disease cured or prevented by a given exposure, trait or intervention . Am J Epidemiol 1974;;99:325-332.
18 +
Mann JI, Doll R, Thorogood M, et al:  Risk factors for myocardial infarction in young women . Br J Prev Soc Med 1976;;30:94-100.
19 +
Gordon T, Castelli WP, Hjortland MC, et al:  High density lipoprotein as a protective factor against coronary heart disease: The Farmingham Study . Am J Med 1977;;62:707-714.
20 +
Viskum K, Astvad K, Fabricius-Bjerre N, et al:  Blood groups and acute myocardial infarction . Dan Med Bull 1975;;22:126-128.
21 +
Medalie JH, Levene C, Papier C, et al:  Blood groups, myocardial infarction and angina pectoris among 10,000 adult males . N Engl J Med 1971;;285:1348-1353.
22 +
Jick H, Slone D, Westerholm B, et al:  Venous thromboembolic disease and ABO blood type: A cooperative study . Lancet 1969;;1:539-542.
23 +
Ionescu DA, Marcu I, Bicescu E:  Cerebral thrombosis, cerebral hemorrhage and ABO blood group . Lancet 1976;;1:278-280.
24 +
Mourant AE, Kopec AC, Domaniewska-Sobczak K:  Blood groups and blood clotting . Lancet 1971;;1:223-227.
25 +
Harvald B, Hauge M:  Coronary occlusion in twins . Acta Genet Med Gemellol 1970;;19:248-250.
26 +
Slack J, Evans KA:  The increased risk of death from ischaemic heart disease in first degree relatives of 121 men and 96 women with ischaemic heart disease . J Med Genet 1966;; 3:239-257.
27 +
Jenkins CD:  Recent evidence supporting psychologic and social risk factors for coronary disease . N Engl J Med 1976;;294:987-1038.
28 +
Haynes SC, Feinleib M, Levine S, et al:  The relationship of psychosocial factors to coronary heart disease in the Framingham Study: II. Prevalence of coronary heart disease . Am J Epidemiol 1978;;107:384-402.
29 +
Oliver MF: in McDonald L (ed): Pathogenesis and Treatment of Occlusive Vascular Disease . Philadelphia, JB Lippincott Co, 1960;.
30 +
Szajderman M, Oliver MF:  Spontaneous premature menopause, ischaemic heart disease and serum lipids . Lancet 1963;;1:962-965.
31 +
Rosenberg L, Hennekens CH, Rosner B, et al:  Early menopause and the risk of myocardial infarction . Am J Obstet Gynecol 1981;;139:47-51.
32 +
Gordon T, Kannel WB, Hjortland MC, et al:  Menopause and coronary heart disease . Ann Intern Med 1978;;89:157-161.
33 +
Furman RH:  Are gonadal hormones (estrogens and androgens) of significance in the development of ischemic heart disease? Ann NY Acad Sci 1968;;149:822-833.
34 +
Heller RF, Jacobs HS:  Coronary heart disease in relation to age, sex, and the menopause . Br Med J 1978;;1:472-474.
35 +
Coronary Drug Project Research Group:  The coronary drug project: Initial funding leading to modifications of its research protocol . JAMA 1970;;214:1303-1313.
36 +
Beard CM, Fuster V, Annegers JF:  Reproductive history risk factors among women less than age 60 years with coronary heart disease (CHD)  in Rochester, MN: A case-control study. Read before the Society for Epidemiologic Research Meeting, Cincinnati, June 16, 1982 .

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1 +
 The Pooling Project Research Group: Relationship of blood pressure, serum cholesterol, smoking habit, relative weight and ECG abnormalities to incidence of major coronary events: Final report of the Pooling Project . J Chronic Dis 1978;;31:201-306.
2 +
Slone D, Shapiro S, Rosenberg L, et al:  Relation of cigarette smoking to myocardial infarction in young women . N Engl J Med 1978;;298:1273-1276.
3 +
Rosenberg L, Shapiro S, Kaufman DW, et al:  Cigarette smoking in relation to the risk of myocardial infarction in young women: Modifying influence of age and predisposing factors . Int J Epidemiol 1980;;9:57-63.
4 +
Doll R, Peto R:  Mortality in relation to smoking: Twenty years' observation on male British doctors . Br Med J 1976;;2:1525-1536.
5 +
Shapiro S, Slone D, Rosenberg L, et al:  Oral contraceptive use in relation to myocardial infarction . Lancet 1979;;1:743-746.
6 +
Slone D, Kaufman DW, Shapiro S, et al:  Risk of myocardial infarction in relation to current and discontinued oral contraceptive use . N Engl J Med 1981;;305:420-424.
7 +
Rosenberg L, Slone D, Shapiro S, et al:  Noncontraceptive estrogens and myocardial infarction in young women . JAMA 1980;;244:339-342.
8 +
Rosenberg L, Slone D, Shapiro S, et al:  Aspirin and myocardial infarction in young women . Am J Public Health 1982;;72:389-391.
9 +
Rosenberg L, Slone D, Shapiro S, et al:  Coffee drinking and myocardial infarction in younger women . Am J Epidemiol 1980;;111:675-681.
10 +
Rosenberg L, Slone D, Shapiro S, et al:  Alcoholic beverages and myocardial infarction in young women . Am J Public Health 1981;; 71:82-84.
11 +
Ischaemic Heart Disease Registers: Report of the Fifth Working Group . Copenhagen, World Health Organization, 1971;.
12 +
Manual of Laboratory Operations: Lipid Research Clinics Program, US Dept of Health, Education, and Welfare publication (NIH) 75-628. Government Printing Office, 1974.
13 +
Haynes SC, Levine S, Scotch N, et al:  The relationship of psychosocial factors to coronary heart disease in the Framingham Study: I. Methods and risk factors . Am J Epidemiol 1978;;107:362-383.
14 +
Miettinen OS:  Estimability and estimation in case-referent studies . Am J Epidemiol 1976;; 103:226-235.
15 +
Mantel N, Haenszel W:  Statistical aspects of the analysis of data from retrospective studies of disease . JNCI 1959;;22:719-748.
16 +
Armitage P: Statistical Methods in Medical Research . New York, John Wiley & Sons Inc, 1979;, pp 319-320.
17 +
Miettinen OS:  Proportion of disease cured or prevented by a given exposure, trait or intervention . Am J Epidemiol 1974;;99:325-332.
18 +
Mann JI, Doll R, Thorogood M, et al:  Risk factors for myocardial infarction in young women . Br J Prev Soc Med 1976;;30:94-100.
19 +
Gordon T, Castelli WP, Hjortland MC, et al:  High density lipoprotein as a protective factor against coronary heart disease: The Farmingham Study . Am J Med 1977;;62:707-714.
20 +
Viskum K, Astvad K, Fabricius-Bjerre N, et al:  Blood groups and acute myocardial infarction . Dan Med Bull 1975;;22:126-128.
21 +
Medalie JH, Levene C, Papier C, et al:  Blood groups, myocardial infarction and angina pectoris among 10,000 adult males . N Engl J Med 1971;;285:1348-1353.
22 +
Jick H, Slone D, Westerholm B, et al:  Venous thromboembolic disease and ABO blood type: A cooperative study . Lancet 1969;;1:539-542.
23 +
Ionescu DA, Marcu I, Bicescu E:  Cerebral thrombosis, cerebral hemorrhage and ABO blood group . Lancet 1976;;1:278-280.
24 +
Mourant AE, Kopec AC, Domaniewska-Sobczak K:  Blood groups and blood clotting . Lancet 1971;;1:223-227.
25 +
Harvald B, Hauge M:  Coronary occlusion in twins . Acta Genet Med Gemellol 1970;;19:248-250.
26 +
Slack J, Evans KA:  The increased risk of death from ischaemic heart disease in first degree relatives of 121 men and 96 women with ischaemic heart disease . J Med Genet 1966;; 3:239-257.
27 +
Jenkins CD:  Recent evidence supporting psychologic and social risk factors for coronary disease . N Engl J Med 1976;;294:987-1038.
28 +
Haynes SC, Feinleib M, Levine S, et al:  The relationship of psychosocial factors to coronary heart disease in the Framingham Study: II. Prevalence of coronary heart disease . Am J Epidemiol 1978;;107:384-402.
29 +
Oliver MF: in McDonald L (ed): Pathogenesis and Treatment of Occlusive Vascular Disease . Philadelphia, JB Lippincott Co, 1960;.
30 +
Szajderman M, Oliver MF:  Spontaneous premature menopause, ischaemic heart disease and serum lipids . Lancet 1963;;1:962-965.
31 +
Rosenberg L, Hennekens CH, Rosner B, et al:  Early menopause and the risk of myocardial infarction . Am J Obstet Gynecol 1981;;139:47-51.
32 +
Gordon T, Kannel WB, Hjortland MC, et al:  Menopause and coronary heart disease . Ann Intern Med 1978;;89:157-161.
33 +
Furman RH:  Are gonadal hormones (estrogens and androgens) of significance in the development of ischemic heart disease? Ann NY Acad Sci 1968;;149:822-833.
34 +
Heller RF, Jacobs HS:  Coronary heart disease in relation to age, sex, and the menopause . Br Med J 1978;;1:472-474.
35 +
Coronary Drug Project Research Group:  The coronary drug project: Initial funding leading to modifications of its research protocol . JAMA 1970;;214:1303-1313.
36 +
Beard CM, Fuster V, Annegers JF:  Reproductive history risk factors among women less than age 60 years with coronary heart disease (CHD)  in Rochester, MN: A case-control study. Read before the Society for Epidemiologic Research Meeting, Cincinnati, June 16, 1982 .

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