Reuterwall C, Hallqvist J, Ahlbom A, De Faire U, Diderichsen F, Hogstedt C, Pershagen G, Theorell T, Wiman B, Wolk A
National Institute for Working Life, Department of Occupational Health, Institute of Environmental Medicine, Division of Social Medicine, Karolinska Institute, Sweden.
J Intern Med. 1999 Aug;246(2):161-74. doi: 10.1046/j.1365-2796.1999.00554.x.
Middle-aged men have often been the subjects of multifactorial studies of myocardial infarction (MI) risk factors. One major objective of the SHEEP study was to compare the effects of different MI risk factors in women and men.
SHEEP (Stockholm Heart Epidemiology Program) is a population-based case-referent study of causes of MI (first event) in Swedish women and men aged 45-70 years. During the period 1992-94, 2246 cases of MI were identified; 34% of the cases were women and 27% of the cases were fatal. One referent per case was chosen randomly from the Stockholm County population after stratification for the case's sex and age. Logistic regression was used to estimate the relative risks associated with risk factors of primary interest (diabetes, hypercholesterolaemia, hypertriglyceridaemia, hypertension, overweight, physical inactivity, smoking and job strain).
The relative risk estimates ranged from 1.5 to 4.4 in women and from 1.3 to 2.9 in men (results for nonfatal cases and their referents). None of the 95% confidence intervals included 1.0. The relative risks were higher in the women than in the men (101-180%). The absolute risks, however, were all lower in the women than in the men. Estimates of Rothman's synergy index for gender ranged from 1.0 (hypertension) to 1.8 (current smoking).
The indications of some effect modification due to sex (stronger risks in men for certain exposures) invoke the question of possible mechanisms.
中年男性常常是心肌梗死（MI）危险因素多因素研究的对象。SHEEP研究的一个主要目的是比较不同MI危险因素在女性和男性中的作用。
SHEEP（斯德哥尔摩心脏流行病学项目）是一项基于人群的病例对照研究，研究对象为瑞典45至70岁的女性和男性MI（首次发病）的病因。在1992 - 1994年期间，共识别出2246例MI病例；其中34%为女性，27%的病例死亡。在根据病例的性别和年龄进行分层后，从斯德哥尔摩县人群中为每个病例随机选择一名对照。采用逻辑回归来估计与主要关注的危险因素（糖尿病、高胆固醇血症、高甘油三酯血症、高血压、超重、缺乏体育活动、吸烟和工作压力）相关的相对风险。
女性的相对风险估计值在1.5至4.4之间，男性在1.3至2.9之间（非致命病例及其对照的结果）。所有95%置信区间均不包括1.0。女性的相对风险高于男性（高出101 - 180%）。然而，女性的绝对风险均低于男性。性别方面的Rothman协同指数估计值范围从1.0（高血压）到1.8（当前吸烟）。
一些因性别导致的效应修饰迹象（某些暴露因素在男性中风险更强）引发了关于可能机制的问题。
