Of 35 patients with acute myocardial infarction (AMI) at the age of 40 years or less, 32 (91%) smoked and only three patients were non-smokers. The age at AMI related significantly to the extent of smoking (p < 0.001, Kruskall-Wallis test). Five patients with AMI at the age < 30 years smoked more heavily than the 30 with AMI at the age of 30-40 years (p = 0.04, Mann Whitney U test). Heavy smoking men > 30 years at the AMI had a Q-wave infarction as often (11 of 13 (85%)) as those with multivessel disease or a coronary artery occlusion (8 of 9 (89% ) and 14 of 16 (88% ) respectively) on coronary arteriography after the infarction. Smoking may be the most important modifiable risk factor in young patients with AMI.
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References
1.
Avogaro P., Rubba P. and Mancini M. (1993). Smoking and cardiovascular events: Biological events. J Cardiovascular Risk;3, 373-8
2.
Barbash G.I., White H D., Modan M., Daiz R., Hampton J R., Heikkila J., Kristinsson A., Moupoulos S., Pao-Lasso E.A., Van Der Werf T. et al (1995). Acute myocardial infarction in the young - the role of smoking. The Investigators of the International Tissue Plasminogen Activator/Streptokinase Mortality Trial. Eur Heart J;16, 295-6
3.
Dyerberg J., Stender S., Eg Andersen G., Færgeman O., Haghfelt T., Hviid T., Jensen T.J., Leth A., Sigurd B. and Skovby F. (The Lipid Group within the Danish Society of Cardiology, Section for Preventive Cardiology) (1990). Recommendations for chemical departments: lipid and lipoprotein measurements . Ugeskr Laeg;152, 1434-7
4.
Feldager Hansen E., Tingsted Andersen L. and Von Eyben F.E. (1993). Cigarette smoking and age at first myocardial infarction, and influence of gender and extent of smoking. Am J Cardiol;71, 1439-42
5.
Fuster V. and Lewis A. (1994). Conner Memorial Lecture. Mechanisms leading to myocardial infarction: insights from studies of vascular biology. Circulation;90, 2126-46
6.
Genest J.J. Jr, Mcnamara J.R., Upson B. et al (1991). Prevalence of familial hyperhomocyst (e) inemia in men with premature coronary artery disease. Arterioscler Thromb; 11, 1129-
7.
Gertler M. M and WHITE P D (1954). Coronary Heart Disease in Young Adults. A Multidisciplinary StudyCambridge, Massachusetts , USA: Harvard University Press
8.
Gohlke H., Stuertenhofecker P., Thilo A., Droste C., Goenandt L. and Roskamm H. (1981). Coronary angiographic findings and risk factors in postinfarction patients under the age of 40. In: Myocardial Infarction at Young Age, 61-77. (H Roskamm, ed). Berlin: Springer Verlag
9.
Gouldbourt U. and Medalie J.H. (1977). Characteristics of smokers, non-smokers and ex-smokers among 10,000 adult males in Israel. Am J Epidemiol;105, 75-86
10.
Gouldbourt U, de Faire U and Berg K (eds) (1994 ). Genetic Factors in Coronary Heart Disease. Lancaster, UK: Kluwer Academic Publishers
11.
Green F., Hamsten A., Blombaeck M. and Humphries S. (1993). The role of beta-fibrinogen genotype in determining plasma fibrinogen levels in young survivors of myocardial infarction and healthy controls from Sweden. Thromb Haemost;70, 9215-20
12.
Hamsten A., Waldius G., Szamosi A., Dahlen G. and de Faire U. (1986). Relationship of angiographically defined coronary artery disease to serum lipoproteins and apolipoproteins in young survivors of myocardial infarction. Circulation;73, 1097-110
13.
Jeremy J.Y., Mikhailidis D.P. and Pittilo R.M. (1995). Cigarette smoking and cardiovascular disease. J Roy Soc Health;115,289-95
14.
Kannel W.B. (1992). The Framingham experience. In: Coronary Heart Disease Epidemiology from Aetiology to Public Health, 67-82. ( M Marmot and P Elliot, eds). Oxford: Oxford University Press
15.
Larsson B. (1992). Obesity and body fat distribution as predictors of coronary heart disease. In: Coronary Heart Disease Epidemiology from Aetiology to Public Health, 233-241. (M Marmot and P Elliot, eds). Oxford: Oxford University Press
16.
Mansoor M.A. (1994). Redox status and protein binding of plasma homocysteine and related thiols in healthy subjects and in plasma with hyperhomocysteinemia. Analytical methods and clinical studies. (Thesis.) Bergen , Norway: University of Bergen
17.
M I D D E L L E V E T I D S U D VA L G E T (Committee on Median Survival in Denmark) (1994). 10. delrapport. Hjertesygdom i Danmark (Cardiac Disease in Denmark). Copenhagen , Denmark: Ministry of Health
18.
Morris J.N. (1992). Exercise versus heart attack: history of a hypothesis . In: Coronary Heart Disease Epidemiology from Aetiology to Public Health, 242-5. (M Marmot and P Elliot, eds). Oxford: Oxford University Press
19.
Negri E., L C., Nobili A., D'Avanzo B., Bechi S. and Gissi-Efrim Investigators (1994 ). Cigarette smoking and acute myocardial infarction. Eur J Epidemiol;10, 361-6
20.
Nyboe J., Jensen G., Appleyard M. and Schnohr P. (1991). Smoking and the risk of first acute myocardial infarction. Am Heart J;122,438-47
21.
Osler M. (1992). Danskernes rygevaner (Smoking habits in Denmark - in Danish). Copenhagen.
22.
Parish S., Peto R., Youngman L., Barton J., Jayne K., Clarke R., Appleby P., Lyon V., Cedeholm-Williams S., Marshall J. and Sleight P. (1995). Cigarette smoking, tar yield, and non-fatal myocardial infarction: 14,000 cases and 32,000 controls in the United Kingdom. BMJ;311, 471-7
23.
Stamler J. (1992). Established major coronary risk factors. In: Coronary Heart Disease Epidemiology from Aetiology to Public Health , 35-66. (M Marmot and P Elliot, eds). Oxford: Oxford University Press
24.
Stuertenhofecker P., Samek L., Droste C., Gohlke H., Petersen J. and Roskamm H. (1981). Prognosis of coronary heart disease and progression of coronary arteriosclerosis in postinfarction patients under the age of 40 . In: Myocardial Infarction at Young Age, 82-91. ( H Roskamm, ed). Berlin: Springer Verlag
25.
Tejada C., Strong J P., Montenegro M R., Restrepo C. and Solberg L A. (1968). Distribution of coronary and aortic atherosclerosis by geographic location, race, and sex. Lab Invest;18, 509-26
26.
Us Department Of Health And Human Services ( 1983). The Health Consequences of Smoking. Cardiovascular Disease. A Report of the US Surgeon General. Maryland, USA: US Department of Health and Human Services
