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Epidemiology
Research
Myocardial infarction in the Wisconsin Longitudinal Study: the interaction among environmental, health, social, behavioural and genetic factors
  1. Tina K Gonzales1,
  2. James A Yonker1,
  3. Vicky Chang1,
  4. Carol L Roan1,
  5. Pamela Herd1,2,
  6. Craig S Atwood3,4,5
  1. 1Department of Sociology, University of Wisconsin, Madison, Wisconsin, USA
  2. 2La Follete School of Public Affairs, University of Wisconsin, Madison, Wisconsin, USA
  3. 3Department of Medicine, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin, USA
  4. 4Geriatric Research, Education and Clinical Center, Veterans Administration Hospital, Madison, Wisconsin, USA
  5. 5School of Exercise, Biomedical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia
  1. Correspondence to Dr Craig S Atwood; csa{at}medicine.wisc.edu

Abstract

Objectives This study examined how environmental, health, social, behavioural and genetic factors interact to contribute to myocardial infarction (MI) risk.

Design Survey data collected by Wisconsin Longitudinal Study (WLS), USA, from 1957 to 2011, including 235 environmental, health, social and behavioural factors, and 77 single- nucleotide polymorphisms were analysed for association with MI. To identify associations with MI we utilized recursive partitioning and random forest prior to logistic regression and chi-squared analyses.

Participants 6198 WLS participants (2938 men; 3260 women) who (1) had a MI before 72 years and (2) had a MI between 65 and 72 years.

Results In men, stroke (LR OR: 5.01, 95% CI 3.36 to 7.48), high cholesterol (3.29, 2.59 to 4.18), diabetes (3.24, 2.53 to 4.15) and high blood pressure (2.39, 1.92 to 2.96) were significantly associated with MI up to 72 years of age. For those with high cholesterol, the interaction of smoking and lower alcohol consumption increased prevalence from 23% to 41%, with exposure to dangerous working conditions, a factor not previously linked with MI, further increasing prevalence to 50%. Conversely, MI was reported in <2.5% of men with normal cholesterol and no history of diabetes or depression. Only stroke (4.08, 2.17 to 7.65) and diabetes (2.71, 1.81 to 4.04) by 65 remained significantly associated with MI for men after age 65. For women, diabetes (5.62, 4.08 to 7.75), high blood pressure (3.21, 2.34 to 4.39), high cholesterol (2.03, 1.38 to 3.00) and dissatisfaction with their financial situation (4.00, 1.94 to 8.27) were significantly associated with MI up to 72 years of age. Conversely, often engaging in physical activity alone (0.53, 0.32 to 0.89) or with others (0.34, 0.21 to 0.57) was associated with the largest reduction in odds of MI. Being non-diabetic with normal blood pressure and engaging in physical activity often lowered prevalence of MI to 0.2%. Only diabetes by 65 (4.25, 2.50 to 7.24) and being exposed to dangerous work conditions at 54 (2.24, 1.36 to 3.69) remained significantly associated with MI for women after age 65, while still menstruating at 54 (0.46, 0.23 to 0.91) was associated with reduced odds of MI.

Conclusions Together these results indicate important differences in factors associated with MI between the sexes, that combinations of factors greatly influence the likelihood of MI, that MI-associated factors change and associations weaken after 65 years of age in both sexes, and that the limited genotypes assessed were secondary to environmental, health, social and behavioral factors.

  • Wisconsin Longitudinal Study
  • gene-environment interactions
  • SOCIAL MEDICINE
  • gender

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

https://doi.org/10.1136/bmjopen-2016-011529

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    Footnotes

    • Disclaimer The opinions expressed herein are those of the authors. The contents do not represent the views of the Department of Veterans Affairs or the US government.

    • Contributors CSA and TG conceptualised the study. CLR, PH and CSA collected saliva samples and performed genotyping analyses. TG, JAY, VC and CLR identified the variables and performed the statistical analyses on the Wisconsin Longitudinal Study data set. CSA, JAY and PH directed the statistical analyses. TG and CSA drafted the manuscript. All authors critically reviewed the manuscript and approved the final version.

    • Funding Since 1991, the WLS has been supported principally by the National Institute on Aging (AG-9775, AG-21079 and AG-033285), with additional support from the Vilas Estate Trust, the National Science Foundation, the Spencer Foundation and the Graduate School of the University of Wisconsin-Madison.

    • Competing interests None declared.

    • Ethics approval Ethics approval was provided by the Health Sciences Institutional Review Board, University of Wisconsin–Madison.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement A public use file of data from the Wisconsin Longitudinal Study collected over the last 58 years is available from the WLS, University of Wisconsin-Madison, 1180 Observatory Drive, Madison, WI 53706, and online at http://www.ssc.wisc.edu/wlsresearch/data