title: Risk factors for myocardial infarction in women and men: insights from the INTERHEART study.
abstract: OBJECTIVE
  Coronary heart disease (CHD) is a leading cause of death among men and women globally. Women develop CHD about 10 years later than men, yet the reasons for this are unclear. The purpose of this report is to determine if differences in risk factor distributions exist between women and men across various age categories to help explain why women develop acute MI later than men.
  
  
  RESULTS
  We used the INTERHEART global case-control study including 27 098 participants from 52 countries, 6787 of whom were women. The median age of first acute MI was higher in women than men (65 vs. 56 years; P < 0.0001). Nine modifiable risk factors were associated with MI in women and men. Hypertension [2.95(2.66 -3.28) vs. 2.32(2.16-2.48)], diabetes [4.26(3.68-4.94) vs. 2.67(2.43-2.94), physical activity [0.48(0.41-0.57) vs. 0.77(0.71-0.83)], and moderate alcohol use [0.41(0.34-0.50) vs. 0.88(0.82-0.94)] were more strongly associated with MI among women than men. The association of abnormal lipids, current smoking, abdominal obesity, high risk diet, and psychosocial stress factors with MI was similar in women and men. Risk factors associations were generally stronger among younger individuals compared to older women and men. The population attributable risk (PAR) of all nine risk factors exceeded 94%, and was similar among women and men (96 vs. 93%). Men were significantly more likely to suffer a MI prior to 60 years of age than were women, however, after adjusting for levels of risk factors, the sex difference in the probability of MI cases occurring before the age of 60 years was reduced by more than 80%.
  
  
  CONCLUSIONS
  Women experience their first acute MI on average 9 years later than men. Nine modifiable risk factors are significantly associated with acute MI in both men and women and explain greater than 90% of the PAR. The difference in age of first MI is largely explained by the higher risk factor levels at younger ages in men compared to women.
authors.affiliation: Population Health Research Institute, McMaster University, Hamilton, ON, Canada. anands@mcmaster.ca
authors.forename: Sonia S
authors.initials: SS
authors.lastname: Anand
authors.forename: Shofiqul
authors.initials: S
authors.lastname: Islam
authors.forename: Annika
authors.initials: A
authors.lastname: Rosengren
authors.forename: Maria Grazia
authors.initials: MG
authors.lastname: Franzosi
authors.forename: Krisela
authors.initials: K
authors.lastname: Steyn
authors.forename: Afzal Hussein
authors.initials: AH
authors.lastname: Yusufali
authors.forename: Matyas
authors.initials: M
authors.lastname: Keltai
authors.forename: Rafael
authors.initials: R
authors.lastname: Diaz
authors.forename: Sumathy
authors.initials: S
authors.lastname: Rangarajan
authors.forename: Salim
authors.initials: S
authors.lastname: Yusuf
mesh_terms: D000328:Adult; D000367:Age Factors; D000428:Alcohol Drinking / Q000453:epidemiology / Q000517:prevention & control; D004812:Epidemiologic Methods; D015444:Exercise / Q000502:physiology; D005260:Female; D014943:Global Health; D006801:Humans; D006973:Hypertension / Q000150:complications* / Q000453:epidemiology; D008019:Life Style; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology / Q000209:etiology*; D009765:Obesity / Q000150:complications* / Q000453:epidemiology; D012737:Sex Factors; D012907:Smoking / Q000009:adverse effects / Q000453:epidemiology