Gonzales Tina K, Yonker James A, Chang Vicky, Roan Carol L, Herd Pamela, Atwood Craig S
Department of Sociology, University of Wisconsin, Madison, Wisconsin, USA.
La Follete School of Public Affairs, University of Wisconsin, Madison, Wisconsin, USA.
BMJ Open. 2017 Jan 23;7(1):e011529. doi: 10.1136/bmjopen-2016-011529.
This study examined how environmental, health, social, behavioural and genetic factors interact to contribute to myocardial infarction (MI) risk.
Survey data collected by Wisconsin Longitudinal Study (WLS), USA, from 1957 to 2011, including 235 environmental, health, social and behavioural factors, and 77 single- nucleotide polymorphisms were analysed for association with MI. To identify associations with MI we utilized recursive partitioning and random forest prior to logistic regression and chi-squared analyses.
6198 WLS participants (2938 men; 3260 women) who (1) had a MI before 72 years and (2) had a MI between 65 and 72 years.
In men, stroke (LR OR: 5.01, 95% CI 3.36 to 7.48), high cholesterol (3.29, 2.59 to 4.18), diabetes (3.24, 2.53 to 4.15) and high blood pressure (2.39, 1.92 to 2.96) were significantly associated with MI up to 72 years of age. For those with high cholesterol, the interaction of smoking and lower alcohol consumption increased prevalence from 23% to 41%, with exposure to dangerous working conditions, a factor not previously linked with MI, further increasing prevalence to 50%. Conversely, MI was reported in <2.5% of men with normal cholesterol and no history of diabetes or depression. Only stroke (4.08, 2.17 to 7.65) and diabetes (2.71, 1.81 to 4.04) by 65 remained significantly associated with MI for men after age 65. For women, diabetes (5.62, 4.08 to 7.75), high blood pressure (3.21, 2.34 to 4.39), high cholesterol (2.03, 1.38 to 3.00) and dissatisfaction with their financial situation (4.00, 1.94 to 8.27) were significantly associated with MI up to 72 years of age. Conversely, often engaging in physical activity alone (0.53, 0.32 to 0.89) or with others (0.34, 0.21 to 0.57) was associated with the largest reduction in odds of MI. Being non-diabetic with normal blood pressure and engaging in physical activity often lowered prevalence of MI to 0.2%. Only diabetes by 65 (4.25, 2.50 to 7.24) and being exposed to dangerous work conditions at 54 (2.24, 1.36 to 3.69) remained significantly associated with MI for women after age 65, while still menstruating at 54 (0.46, 0.23 to 0.91) was associated with reduced odds of MI.
Together these results indicate important differences in factors associated with MI between the sexes, that combinations of factors greatly influence the likelihood of MI, that MI-associated factors change and associations weaken after 65 years of age in both sexes, and that the limited genotypes assessed were secondary to environmental, health, social and behavioral factors.
本研究探讨环境、健康、社会、行为和遗传因素如何相互作用以影响心肌梗死（MI）风险。
分析美国威斯康星纵向研究（WLS）于1957年至2011年收集的调查数据，包括235项环境、健康、社会和行为因素以及77个单核苷酸多态性，并分析其与MI的关联。为确定与MI的关联，在进行逻辑回归和卡方分析之前，我们使用了递归划分和随机森林方法。
6198名WLS参与者（2938名男性；3260名女性），他们（1）在72岁之前发生过MI，以及（2）在65至72岁之间发生过MI。
在男性中，中风（似然比OR：5.01，95%置信区间3.36至7.48）、高胆固醇（3.29，2.59至4.18）、糖尿病（3.24，2.53至4.15）和高血压（2.39，1.92至2.96）与72岁之前的MI显著相关。对于高胆固醇患者，吸烟与较低饮酒量的相互作用使患病率从23%增加到41%，而暴露于危险工作环境（一个先前未与MI相关联的因素）进一步使患病率增加到50%。相反，胆固醇正常且无糖尿病或抑郁症病史的男性中，MI报告率低于2.5%。65岁时，只有中风（4.08，2.17至7.65）和糖尿病（2.71，1.81至4.04）在65岁之后仍与男性的MI显著相关。对于女性，糖尿病（5.62，4.08至7.75）、高血压（3.21，2.34至4.39）、高胆固醇（2.03，1.38至3.00）以及对财务状况的不满（4.00，1.94至8.27）与72岁之前的MI显著相关。相反，经常独自进行体育活动（0.53，0.32至0.89）或与他人一起进行体育活动（0.34，0.21至0.57）与MI发生几率的最大降低相关。血压正常且无糖尿病并经常进行体育活动可使MI患病率降至0.2%。65岁时，只有糖尿病（4.25，2.50至7.24）以及54岁时暴露于危险工作环境（2.24，1.36至3.69）在65岁之后仍与女性的MI显著相关，而54岁时仍在月经（0.46，0.23至0.91）与MI发生几率降低相关。
这些结果共同表明，两性中与MI相关的因素存在重要差异，因素组合极大地影响MI的可能性，65岁之后两性中与MI相关的因素发生变化且关联减弱，并且所评估的有限基因型相对于环境、健康、社会和行为因素而言是次要的。
