title: Potentially modifiable classic risk factors and their impact on incident myocardial infarction: results from the EPIC-Potsdam study.
abstract: BACKGROUND
  Prospective data on the importance of established risk factors for myocardial infarction in Germany are sparse.
  
  
  METHODS
  The population-based cohort study European Prospective Investigation into Cancer and Nutrition (EPIC)-Potsdam with 159 incident cases of myocardial infarction (120 men, 39 women) occurring among 26 954 participants (10 463 men, 16 491 women) during an average follow-up time of 4.6 years.
  
  
  METHODS
  We examined the classic, potentially modifiable risk factors smoking, hypertension, hyperlipidemia, diabetes mellitus, abdominal obesity, and sporting inactivity, both individually and in combination, by estimating their prevalence and their relative and population-attributable risks of incident myocardial infarction.
  
  
  RESULTS
  After adjusting for age, sex, educational attainment, alcohol intake, and the respective other classic risk factors the relative risks of myocardial infarction were 3.18 for smoking [95% confidence interval (CI) 2.31, 4.38], 1.84 for hypertension (95% CI 1.27, 2.65), 1.81 for sporting inactivity (95% CI 1.04, 3.15), 1.64 for diabetes (95% CI 1.05, 2.56), 1.62 for abdominal obesity (95% CI 1.03, 2.56), and 1.15 for hyperlipidemia (95% CI 0.84, 1.59). Participants with four or all five significant risk factors had an approximately 11.5-fold higher risk of the coronary event than participants with none or one risk factor. Altogether, 84.3% of myocardial infarctions in the study population were attributable to the presence of the five risk factors smoking, hypertension, diabetes, sporting inactivity, and abdominal obesity.
  
  
  CONCLUSIONS
  The majority of myocardial infarctions in the EPIC-Potsdam cohort were explainable by potentially modifiable classic risk factors. Therefore, besides efforts to investigate novel coronary risk factors, the prevention of coronary disease should focus on strategies to reduce the prevalence of established risk factors.
authors.affiliation: Department of Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany. heidemann@dife.de
authors.forename: Christin
authors.initials: C
authors.lastname: Heidemann
authors.forename: Kurt
authors.initials: K
authors.lastname: Hoffmann
authors.forename: Kerstin
authors.initials: K
authors.lastname: Klipstein-Grobusch
authors.forename: Cornelia
authors.initials: C
authors.lastname: Weikert
authors.forename: Tobias
authors.initials: T
authors.lastname: Pischon
authors.forename: Hans-Werner
authors.initials: HW
authors.lastname: Hense
authors.forename: Heiner
authors.initials: H
authors.lastname: Boeing
mesh_terms: D050153:Abdominal Fat; D000368:Aged; D015331:Cohort Studies; D003327:Coronary Disease / Q000517:prevention & control*; D003920:Diabetes Mellitus / Q000453:epidemiology; D015444:Exercise; D005260:Female; D005500:Follow-Up Studies; D005858:Germany; D006801:Humans; D006949:Hyperlipidemias / Q000453:epidemiology; D006973:Hypertension / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology*; D015995:Prevalence; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012907:Smoking / Q000453:epidemiology