title: Lifestyle factors, medication use and risk for ischaemic heart disease hospitalisation: a longitudinal population-based study.
abstract: BACKGROUND
  Lifestyle factors have been implicated in ischaemic heart disease (IHD) development however a limited number of longitudinal studies report results stratified by cardio-protective medication use.
  
  
  OBJECTIVE
  This study investigated the influence of self-reported lifestyle factors on hospitalisation for IHD, stratified by blood pressure and/or lipid-lowering therapy.
  
  
  METHODS
  A population-based cohort of 14,890 participants aged 45+ years and IHD-free was identified from the Western Australian Health and wellbeing Surveillance System (2004 to 2010 inclusive), and linked with hospital administrative data. Adjusted hazard ratios for future IHD-hospitalisation were estimated using Cox regression.
  
  
  RESULTS
  Current smokers remained at higher risk for IHD-hospitalisation (adjusted HR=1.57; 95% CI: 1.22-2.03) after adjustment for medication use, as did those considered overweight (BMI=25-29 kg/m(2); adjusted HR=1.28; 95% CI: 1.04-1.57) or obese (BMI of ≥30 kg/m(2); adjusted HR=1.31; 95% CI: 1.03-1.66). Weekly leisure-time physical activity (LTPA) of 150 minutes or more and daily intake of 3 or more fruit/vegetable servings reduced risk by 21% (95% CI: 0.64-0.97) and 26% (95% CI: 0.58-0.96) respectively. Benefits of LTPA appeared greatest in those on blood pressure lowering medication (adjusted HR=0.50; 95% CI: 0.31-0.82 [for LTPA<150 mins], adjusted HR=0.64; 95% CI: 0.42-0.96 [for LTPA>=150 mins]). IHD risk in smokers was most pronounced in those taking neither medication (adjusted HR=2.00; 95% CI: 1.41-2.83).
  
  
  CONCLUSIONS
  This study confirms the contribution of previously reported lifestyle factors towards IHD hospitalisation, even after adjustment for antihypertensive and lipid-lowering medication use. Medication stratified results suggest that IHD risks related to LTPA and smoking may differ according to medication use.
authors.affiliation: Edith Cowan University Health and Wellness Institute, Edith Cowan University, Joondalup, Western Australia, Australia ; Edith Cowan University Survey Research Centre, Edith Cowan University, Joondalup, Western Australia, Australia.
authors.forename: Anthony S
authors.initials: AS
authors.lastname: Gunnell
authors.forename: Kristjana
authors.initials: K
authors.lastname: Einarsdóttir
authors.forename: Daniel A
authors.initials: DA
authors.lastname: Galvão
authors.forename: Sarah
authors.initials: S
authors.lastname: Joyce
authors.forename: Stephania
authors.initials: S
authors.lastname: Tomlin
authors.forename: Vicki
authors.initials: V
authors.lastname: Graham
authors.forename: Caroline
authors.initials: C
authors.lastname: McIntyre
authors.forename: Robert U
authors.initials: RU
authors.lastname: Newton
authors.forename: Tom
authors.initials: T
authors.lastname: Briffa
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001315:Australia; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008019:Life Style; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000453:epidemiology*; D012907:Smoking / Q000009:adverse effects