Restricted accessResearch articleFirst published online 2001-12
Risk Stratification of Coronary Heart Disease Through Established and Emerging Lifestyle Factors in a Mediterranean Population: CARDIO2000 Epidemiological Study
Background In recent decades various lifestyle factors have been
associated with the increasing risk of coronary heart disease. The aim of this
study is to assess coronary risk, based on established and emerging lifestyle
risk factors such as smoking habit, physical activity, alcohol consumption and
depression in a Mediterranean population.
Methods During 2000–2001, 535 male and 126 female
patients with a first event of an acute coronary syndrome and 661 controls
matched by sex, age and region were entered into the study. Conditional logistic
regression analysis estimated the relative risks of developing coronary heart
disease under several scenarios.
Results The multivariate analysis showed that stopping smoking is
exponentially related to the reduction of coronary risk. By contrast, passive
smoking increases the risk from 48% to 112%. Familial
smoking habits are related to current smoking status, increasing the coronary
risk fourfold. The effect of depression on coronary risk differs according to
gender (+15% in males vs. 32% in females), and
interacts with retirement, current smoking, physical inactivity, alcohol
consumption and social status, increasing the risk from 15% to
189%. A J-shape association was found between alcohol intake and
coronary risk. Physical inactivity doubles the coronary risk, while long-term
physical activity plays a preventive role in the reduction of coronary risk,
even in the elderly.
Conclusion Analysis of the data showed that the cluster of
established and emerging lifestyle factors poses its particular role for further
investigation in the aetiology of coronary heart disease.
KannelWBMcGeeDLGordonT.A general cardiovascular risk profile: The Framingham
Study. Am J Cardiol1976;
38:46–51.
2.
GottoAM.Interactions of the major risk factors for coronary heart
disease. Am J Med1986;
80:48–55.
3.
HigginsM.Epidemiology and prevention of coronary heart disease in
families. Am J Med2000;
108:387–395.
4.
WilsonPD'agostinoRBLevyDBelangerAMSilbershatzHKannelWB.Prediction of coronary heart disease using risk factor
categories. Circulation1998;
977:1837–1847.
5.
WoodD.Established and emerging cardiovascular risk
factors. Am Heart J2001;
141:49–57.
6.
LabartheD.Epidemiology and prevention of cardiovascular diseases. A global
challenge. Maryland:
An Aspen Publications;
1998.
7.
HallmanTBurellGSetterlindSOdenALisspersJ.Psychosocial risk factors for coronary heart disease, their
importance compared with other risk factors and gender differences in
sensitivity. J Cardiovasc Risk2001;
8:39–49.
8.
RozanskiABlumenthalJKaplanJ.Impact of psychological factors on the pathogenesis of
cardiovascular disease and implications for therapy.
Circulation1999;
99:2192–2217.
9.
Boden-AlbalaBSaccoRL.Lifestyle factors and stroke risk: Exercise, alcohol, diet,
obesity, smoking, drug use, and stress. Curr
Atheroscler Rep2000;
2:160–166.
10.
LiaoYMcGeeDLCooperRSSutkowskiMB.How generalizable are coronary risk prediction models?
Comparison of Framingham and two national cohorts.
Am Heart J1999;
137:837–845.
11.
HaqIURamsayLEYeoWWJacksonPRWallisEJ.Is the Framingham risk function valid for northern European
populations? A comparison of methods for estimating absolute
coronary risk in high-risk men. Heart1999;
81:40–46.
12.
MenottiALantiMPudduPEKromhoutD.Coronary heart disease incidence in northern and southern
European populations: A reanalysis of the Seven Countries study for a
European coronary risk chart. Heart2000;
84:238–244.
13.
PyoralaK.Assessment of coronary heart disease risk in populations with
different levels of risk. Eur Heart J Mar2000;
21:365–370.
14.
MoulopoulosSDAdamopoulosPNDiamantopoulosEICoronary heart disease risk factors in a random sample of
Athenian adults. The Athens Study. Am J Epidemiol1987;
126:882–892.
15.
KalandidiATzonouAToupadakiNA case—control study of coronary heart disease in
Athens, Greece. Int J Epidemiol Dec1992;
21:1074–1080.
RothmanK-JGreenlandS.Modern epidemiology. London:
Lippincott Williams #38;#38; Wilkins;
1999:
94–115.
18.
PateRRPrattMBlairSNHaskellWLPhysical activity and public health. JAMA1995;
273:402–407.
19.
KlatskyALFriedmanGDSiegelaubAB.Alcohol use and cardiovascular disease: The Kaiser —
Permanente experience. Circulation1981; 64:
III-32–III-41.
20.
RadloffLS.The CES-D scale: A self-report depression scale for research in
the general population. Appl Psychological
Measurement1977;
1:385–401.
21.
HosmerDLemeshowS.Applied logistic regression. New
York: John Wiley #38;#38; Sons;
1989:
106–118.
22.
OckeneISMillerNH.Cigarette smoking, cardiovascular disease, and stroke: A
statement for healthcare professionals from the American Heart Association.
American Heart Association Task Force on Risk Reduction.
Circulation1998;
96:3243–3247.
23.
DollRPetoRWheatleyKGrayR.Mortality in relation to smoking: 40 years observations on male
British doctors. BMJ1994;
309:901–911.
24.
HeJVupputuriSAllenKPrerostMRHughesJWheltonPK.Passive smoking and the risk of coronary heart disease: A
meta-analysis of epidemiologic studies. N Engl J Med1999;
340:12920–12926.
25.
EverettSAWarrenCWSharpDInitiation of cigarette smoking and subsequent smoking behaviour
among U.S. high school students. Prev Med Nov1999;
29:327–333.
26.
KettererMWFitzgeraldFThayerBMoragaRMahrGKeteyianSJPsychosocial and traditional risk factors in early ischaemic
heart disease: Cross-sectional correlates. J
Cardiovasc Risk2000;
76:409–413.
27.
JonssonDRosengrenADotevallALappasGWilhelmsenL.Job control, job demands and social support at work in relation
to cardiovascular risk factors in MONICA 1995 Goteborg.
J Cardiovasc Risk1999;
6:379–385.
