Negri E, La Vecchia C, Franzosi M G, Tognoni G
Istituto di Richerche Farmacologiche Mario Negri, Milan, Italy.
Prev Med. 1995 Nov;24(6):603-9. doi: 10.1006/pmed.1995.1095.
The proportions of nonfatal acute myocardial infarctions (AMI) in Italy attributable to cigarette smoking, body mass, serum cholesterol level, hypertension, diabetes, and family history of AMI (attributable risks, AR) were estimated using data from a case-control study on 614 incident cases of AMI before age 75 with no history of ischemic heart disease and 792 control subjects admitted to the same hospitals where cases were identified for acute, nonneoplastic, cardio- or cerebrovascular conditions not known or suspected to be related to cigarette smoking.
The study was conducted between September 1988 and June 1989 within the framework of the GISSI-2 clinical trial. We assumed a multiplicative model and thus the risk attributable to several factors combined is not the sum of those attributable to the single factors.
Overall the AR of smoking was 49%, and for cholesterol, body mass, family history of AMI, hypertension, and diabetes the AR were 49, 16, 14, 13, and 6%, respectively. Together these factors explained 85% of AMI cases. Though differences emerged for each single factor, the proportion of AMI explained by the six factors together was approximately the same for both sexes, while these factors accounted for 97% of AMI cases before age 50 (and smoking alone for 70%) and for 80% after age 50.
This study confirms that interventions on well-defined risk factors could, in principle, lead to the avoidance of the great majority of myocardial infarctions in this population (i.e., about 80% before age 75 and about 95% before age 50).
利用一项病例对照研究的数据，估算了意大利非致命性急性心肌梗死（AMI）中归因于吸烟、体重、血清胆固醇水平、高血压、糖尿病和AMI家族史（归因风险，AR）的比例。该病例对照研究纳入了614例75岁之前发生的、无缺血性心脏病病史的AMI新发病例，以及792名对照者，这些对照者来自与病例相同的医院，因急性、非肿瘤性、心血管或脑血管疾病入院，这些疾病未知或疑似与吸烟无关。
该研究于1988年9月至1989年6月在GISSI - 2临床试验的框架内进行。我们采用了乘法模型，因此几个因素共同导致的风险并非单个因素导致风险的总和。
总体而言，吸烟的归因风险为49%，胆固醇、体重、AMI家族史、高血压和糖尿病的归因风险分别为49%、16%、14%、13%和6%。这些因素共同解释了85%的AMI病例。尽管每个单一因素存在差异，但这六个因素共同解释的AMI比例在男女两性中大致相同，而这些因素在50岁之前的AMI病例中占97%（仅吸烟占70%），在50岁之后占80%。
本研究证实，对明确的风险因素进行干预原则上可避免该人群中的绝大多数心肌梗死（即75岁之前约80%，50岁之前约95%）。
