Influence of dietary patterns on the risk of acute myocardial infarction in China population: the INTERHEART China study / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Some dietary patterns are risk factors for acute myocardial infarction (AMI). Chinese traditional food and habits vary from other cultures. The present study determined whether different dietary patterns were associated with AMI in Chinese people.</p><p><b>METHODS</b>We conducted a case-control study. There were 1312 cases of first AMI and 2235 control subjects who did not have previous angina, diabetes mellitus, hypertension or stroke. Controls were matched to cases on age and gender. Diet was measured with a validated, 19 item food frequency questionnaire. We identified three major dietary patterns using factor analysis: vitamin and microelement pattern (high intake of vegetables, fruits and tofu), carbohydrate pattern (high in grain), and fat and protein pattern (high in meat, fish, eggs and fried foods).</p><p><b>RESULTS</b>After adjusting for all risk factors, the vitamin and microelement pattern was inversely associated with AMI risk (global P value, 0.0001). Compared with the first quartile, the adjusted ORs of AMI were 0.81 (95%CI: 0.66 - 1.00) for the second quartile, 0.67 (95%CI: 0.54 - 0.82) for the third, and 0.70 (95%CI: 0.56 - 0.88) for the fourth. Several dietary frequencies (serves per week) including vegetables, fruits and tofu were closely associated with decrease of AMI risk. Carbohydrate pattern showed weak relationship with AMI. We observed a U-shaped association between frequencies of fat and protein pattern and AMI risk. Excessive fat intake increased the AMI risk. The adjusted OR of AMI associated with the higher level of green vegetables was 0.37 (95%CI: 0.24 - 0.57) in women and 0.65 (95%CI: 0.51 - 0.82) in men (P value for heterogeneity, 0.0140).</p><p><b>CONCLUSIONS</b>Unhealthy dietary intake can increase the AMI risk. Improving intake of vegetables, fruits and tofu have the potential to partially prevent the rising epidemic of cardiovascular disease in China.</p>

Influence of socioeconomic status on acute myocardial infarction in the Chinese population: the INTERHEART China study / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Many researches report that low socioeconomic status (SES) is associated with a higher risk of coronary heart disease (CHD). This study aimed to determine whether levels of education, family income, and other SES were associated with acute myocardial infarction (AMI) in the Chinese population, and to compare the difference in this association between northern and southern regions in China.</p><p><b>METHODS</b>We conducted a case-control study. Cases were first AMI (n = 2909). Controls (n = 2947) were randomly selected and frequency matched to cases on age and sex. SES was measured using education, family income, possessions in the household, and occupation.</p><p><b>RESULTS</b>Low levels of education (8 years) were more common in cases compared to controls (53.4% and 44.1%; P = 0.0001). After adjusting all risk factors, the level of education was associated with AMI risk in the Chinese population (P = 0.0005). The odds ratio (OR) associated with education of 8 years or less, compared with more than 12 years (trade school/college/university) was 1.33 (95%CI 1.12 - 1.59), and for education of 9 - 12 years 1.04 (95%CI 0.88 - 1.33). The proportion of higher income population was more in controls than cases (39.4% and 35.3%). Number of possessions and non-professional occupation were only weakly or not at all independently related to AMI. The adjusted OR associated with the lower education was 2.38 (95%CI 1.67 - 3.39) in women, and 1.18 (95%CI 0.99 - 1.42) in men (P = 0.0001, for heterogeneity). The interaction between levels of education and different regions was significant (P = 0.0206, for interaction).</p><p><b>CONCLUSION</b>Several socioeconomic factors including levels of education and income were closely associated with increase of AMI risk in China, most markedly in northeast and southern area. The effect of education was stronger towards AMI in women than men.</p>

Association of psychological risk factors and acute myocardial infarction in China: the INTER-HEART China study / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Most data about psychological factors relating to acute myocardial infarction (AMI) were obtained from studies carried out in western countries. Results from small descriptive cross-sectional studies in China were inconclusive. The aim of this study was to explore possible associations between psychological risk factors and AMI among the Chinese population with a large-scale case-control study.</p><p><b>METHODS</b>This study was part of the INTER-HEART China study, itself part of the large international INTER-HEART study of cardiovascular risk factors. In this case-control study, 2909 cases and 2947 controls were recruited from 17 cities. Psychological stress, negative life events, depression and controllability of life circumstances were assessed.</p><p><b>RESULTS</b>Cases reported more psychological stress at home or work and odds ratios (ORs) were 3.2 (95%CI 2.1 - 4.9) for permanent stress and 2.1 (95%CI 1.5 - 2.8) for several periods of stress respectively. More cases experienced depression compared with controls (19.6% vs. 9.3%) and ORs were 2.2 (95%CI 1.9 - 2.6). Subjects with 1, 2 and 3 or more depressive symptoms had increased risk of AMI by 2.1, 2.2 and 2.6 fold, respectively, i.e., more depressive symptoms were associated with higher risks of AMI (P for trend < 0.0001). Women had a greater risk of AMI from depression (OR 3.0, 95%CI 2.2 - 4.0) compared to men (OR 2.0, 95%CI 1.6 - 2.4), P for interaction = 0.0364. Negative life events in subjects were associated with increased risk of AMI, OR 1.7 (95%CI 1.4 - 2.0) for one event and 1.8 (95%CI 1.3 - 2.4) for two or more events. High levels of controllability of life circumstances reduced the risk for AMI (OR 0.8, 95%CI 0.7 - 1.0).</p><p><b>CONCLUSIONS</b>Several psychological factors were closely associated with increased AMI risk among Chinese population. Psychological stress had a greater AMI risk in men but depression was more significant among women.</p>