Advertisement

Obesity or smoking: Which factor contributes more to the incidence of myocardial infarction?

Published:April 14, 2016DOI:https://doi.org/10.1016/j.ejim.2016.03.029

      Highlights

      • Past and, more so, current smoking confers greater risk for MI than obesity.
      • Obesity was associated with increased risk of MI for never smokers, not for past or current smokers.
      • Association of current smoking with MI was more pronounced for the 40–54 than the 55–74 year age groups.

      Abstract

      Objective

      Comparing the contributions of smoking and obesity to the risk of myocardial infarction (MI) can help prioritize behavioral modifications. The objective of this study was to determine the relative risk of smoking, obesity and the joint burden on the risk of MI.

      Methods

      This is a retrospective cohort study of data accessed from electronic medical records of the largest health care organization in Israel. The study population included all 738,380 members of Clalit Health Services, with at least one smoking status and one BMI assessment recorded in 2009 or 2010, aged 40–74 years, who were MI-free before 2009. Obesity was defined as BMI >30 kg/m2. New and primary MI between January 1 and December 31, 2011 were recorded.

      Results

      Rates of MI were: 0.18% for non-obese never smokers, 0.25% for obese never smokers, 0.40% for non-obese past smokers, 0.50% for obese past smokers, 0.53% for non-obese current smokers and 0.66% for obese current smokers. Among non-obese individuals, past smokers and current smokers had a greater risk of MI than did never smokers, after adjusting for age, gender and socioeconomic position (OR, 1.45; 95% CI, 1.23–1.70 and OR, 2.35; 95% CI, 2.10–2.63, respectively). The burden of obesity increased the risk of MI for never smokers but the burden of obesity did not elevate the risk of MI when combined with current or past smoking groups, after adjusting for comorbidities.

      Conclusions

      Past and, more so, current smoking confers greater risk for MI than obesity.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to European Journal of Internal Medicine
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Carter B.D.
        • Abnet C.C.
        • Feskanich D.
        • Freedman N.D.
        • Hartge P.
        • Lewis C.E.
        • et al.
        Smoking and mortality—beyond established causes.
        N Engl J Med. 2015; 372: 631-640
      1. Health at a Glance 2013, OECD indicators. http://www.oecd.org/els/health-systems/Health-at-a-Glance-2013.pdf. [Accessed January 21, 2015].

        • Finkelstein E.A.
        • Khavjou O.A.
        • Thompson H.
        • Trogdon J.G.
        • Pan L.
        • Sherry B.
        • et al.
        Obesity and severe obesity forecasts through 2030.
        Am J Prev Med. 2012; 42: 563-570
      2. The Israel National Quality Measures Program Report 2010-2012. http://www.israelhpr.org.il/e/ [accessed January 25, 2015].

        • Lu Y.
        • Hajifathalian K.
        • Ezzati M.
        • Woodward M.
        • Rimm E.B.
        • Danaei G.
        • et al.
        Metabolic mediators of the effects of body-mass index, overweight, and obesity on coronary heart disease and stroke: a pooled analysis of 97 prospective cohorts with 1·8 million participants.
        Lancet. 2014; 383: 970-983
        • Joshy G.
        • Korda R.J.
        • Attia J.
        • Liu B.
        • Bauman A.E.
        • Banks E.
        Body mass index and incident hospitalisation for cardiovascular disease in 158,546 participants from the 45 and Up Study.
        Int J Obes (Lond). 2014; 38: 848-856
        • Yusuf S.
        • Hawken S.
        • Ounpuu S.
        • Dans T.
        • Avezum A.
        • Lanas F.
        • INTERHEART Study Investigators
        • et al.
        Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): case-control study.
        Lancet. 2004; 364: 937-952
        • Pencina M.J.
        • D'Agostino Sr., R.B.
        • Larson M.G.
        • Massaro J.M.
        • Vasan R.S.
        Predicting the 30-year risk of cardiovascular disease: the Framingham Heart Study.
        Circulation. 2009; 119: 3078-3084
        • Merry A.H.
        • Boer J.M.
        • Schouten L.J.
        • Feskens E.J.
        • Verschuren W.M.
        • Gorgels A.P.
        • et al.
        Smoking, alcohol consumption, physical activity, and family history and the risks of acute myocardial infarction and unstable angina pectoris: a prospective cohort study.
        BMC Cardiovasc Disord. 2011; 11: 13
        • Rossi M.
        • Negri E.
        • La Vecchia C.
        • Campos H.
        Smoking habits and the risk of non-fatal acute myocardial infarction in Costa Rica.
        Eur J Cardiovasc Prev Rehabil. 2011; 18: 467-474
        • Iversen B.
        • Jacobsen B.K.
        • Løchen M.L.
        Active and passive smoking and the risk of myocardial infarction in 24,968 men and women during 11 year of follow-up: the Tromsø Study.
        Eur J Epidemiol. 2013; 28: 659-667
        • Huxley R.R.
        • Barzi F.
        • Woo J.
        • Giles G.
        • Lam T.H.
        • Rahimi K.
        • et al.
        • Asia Pacific Cohort Studies Collaboration
        A comparison of risk factors for mortality from heart failure in Asian and non-Asian populations: an overview of individual participant data from 32 prospective cohorts from the Asia-Pacific Region.
        BMC Cardiovasc Disord. 2014; 14: 61
      3. The R Project for Statistical Computing. http://www.R-project.org. [Accessed January 21, 2015].

        • Odeberg J.
        • Freitag M.
        • Forssell H.
        • Vaara I.
        • Persson M.L.
        • Odeberg H.
        • et al.
        The influence of smoking and impaired glucose homoeostasis on the outcome in patients presenting with an acute coronary syndrome: a cross-sectional study.
        BMJ Open. 2014; 4e005077
        • Jensen M.K.
        • Chiuve S.E.
        • Rimm E.B.
        • Dethlefsen C.
        • Tjønneland A.
        • Joensen A.M.
        • et al.
        Obesity, behavioral lifestyle factors, and risk of acute coronary events.
        Circulation. 2008; 117: 3062-3069
        • Tjønneland A.
        • Olsen A.
        • Boll K.
        • Stripp C.
        • Christensen J.
        • Engholm G.
        • et al.
        Study design, exposure variables, and socioeconomic determinants of participation in Diet, Cancer and Health: a population-based prospective cohort study of 57,053 men and women in Denmark.
        Scand J Public Health. 2007; 35: 432-441
        • Kramer C.K.
        • Zinman B.
        • Retnakaran R.
        Are metabolically healthy overweight and obesity benign conditions? A systematic review and meta-analysis.
        Ann Intern Med. 2013; 159: 758-769
        • Mørkedal B.
        • Vatten L.J.
        • Romundstad P.R.
        • Laugsand L.E.
        • Janszky I.
        Risk of myocardial infarction and heart failure among metabolically healthy but obese individuals: HUNT (Nord-Trøndelag Health Study), Norway.
        J Am Coll Cardiol. 2014; 63: 1071-1078
        • Hinnouho G.M.
        • Czernichow S.
        • Dugravot A.
        • Nabi H.
        • Brunner E.J.
        • Kivimaki M.
        • et al.
        Metabolically healthy obesity and the risk of cardiovascular disease and type 2 diabetes: the Whitehall II Cohort Study.
        Eur Heart J. 2015; 36: 551-559
        • Brown R.E.
        • Kuk J.L.
        Consequences of obesity and weight loss: a devil's advocate position.
        Obes Rev. 2015; 16: 77-87
        • Wormser D.
        • Kaptoge S.
        • Di Angelantonio E.
        • Emerging Risk Factors Collaboration
        Separate and combined associations of body-mass index and abdominal adiposity with cardiovascular disease: collaborative analysis of 58 prospective studies.
        Lancet. 2011; 377
        • Shimokata H.
        • Muller D.C.
        • Andres R.
        Studies in the distribution of body fat. III. Effects of cigarette smoking.
        JAMA. 1989; 261: 1169-1173
        • Jensen E.X.
        • Fusch C.
        • Jaeger P.
        • Peheim E.
        • Horber F.F.
        Impact of chronic cigarette smoking on body composition and fuel metabolism.
        J Clin Endocrinol Metab. 1995; 80: 2181-2185
        • Cotter D.G.
        • Schugar R.C.
        • Crawford P.A.
        Ketone body metabolism and cardiovascular disease.
        Am J Physiol Heart Circ Physiol. 2013; 304: H1060-H1076
        • Yusuf S.
        • Hawken S.
        • Ounpuu S.
        • Bautista L.
        • Franzosi M.G.
        • Commerford P.
        • INTERHEART Study Investigators
        • et al.
        Obesity and the risk of myocardial infarction in 27,000 participants from 52 countries: a case-control study.
        Lancet. 2005; 366: 1640-1649
        • Vanni H.
        • Kazeros A.
        • Wang R.
        • Harvey B.G.
        • Ferris B.
        • De B.P.
        • et al.
        Cigarette smoking induces overexpression of a fat-depleting gene AZGP1 in the human.
        Chest. 2009; 135: 1197-1208
        • Kleppinger A.
        • Litt M.D.
        • Kenny A.M.
        • Oncken C.A.
        Effects of smoking cessation on body composition in postmenopausal women.
        J Womens Health (Larchmt). 2010; 19: 1651-1657
        • Barua R.S.
        • Ambrose J.A.
        Mechanisms of coronary thrombosis in cigarette smoke exposure.
        Arterioscler Thromb Vasc Biol. 2013; 33: 1460-1467
        • Barua R.S.
        • Ambrose J.A.
        • Eales-Reynolds L.J.
        • DeVoe M.C.
        • Zervas J.G.
        • Saha D.C.
        Heavy and light cigarette smokers have similar dysfunction of endothelial vasoregulatory activity: an in vivo and in vitro correlation.
        J Am Coll Cardiol. 2002; 39: 1758-1763
        • Gopal D.M.
        • Kalogeropoulos A.P.
        • Georgiopoulou V.V.
        • Smith A.L.
        • Bauer D.C.
        • Newman A.B.
        • et al.
        Cigarette smoking exposure and heart failure risk in older adults: the Health, Aging, and Body Composition Study.
        Am Heart J. 2012; 164: 236-242
        • Celermajer D.S.
        • Adams M.R.
        • Clarkson P.
        • Robinson J.
        • McCredie R.
        • Donald A.
        • et al.
        Passive smoking and impaired endothelium-dependent arterial dilatation in healthy young adults.
        N Engl J Med. 1996; 334: 150-154

      Linked Article

      • Obesity or smoking: Which factor contributes more to the incidence of myocardial infarction? Authors' Reply
        European Journal of Internal MedicineVol. 34
        • Preview
          The authors thank Shiri for his questions and concerns [1] and appreciate the opportunity to respond to them. The primary concern was that the study population may be sicker than the general Israeli population and thus the reported prevalence of obesity and co-morbidities in the study population is not representative of the general Israeli population. We respond to this with two points: the first clarifies our selection of the study population and the second describes disease prevalence data in the Clalit Health System.
        • Full-Text
        • PDF