Risk factors associated with acute myocardial infarction in the São Paulo metropolitan region: a developed region in a developing country

OBJECTIVE: To identify the risk factors associated with acute myocardial infarction (AMI) and their respective powers of association in the São Paulo metropolitan region. METHODS: The cases comprised patients diagnosed with first AMI with an ST segment elevation. The controls were individuals with no known cardiovascular disease. The study comprised 271 cases and 282 controls from 12 hospitals. Risk factors were as follows: ethnic group; educational level; marital status; family income; family history of coronary artery disease; antecedents of arterial hypertension and of diabetes mellitus; hormonal replacement in women; smoking; physical activity; alcohol consumption; total cholesterol, LDL-cholesterol, HDL-cholesterol, triglyceride, and glucose levels; body mass index; and waist-hip ratio (WHR). RESULTS: The following risk factors showed and independent association with AMI: smoking [odds ratio (OR)=5.86; 95% confidence interval (CI) 3.25-10.57; P < 0.00001); waist-hip ratio (first vs. third tertile) (OR=4.27; 95% CI 2.28-8.00; P<0.00001); antecedents of arterial hypertension (OR=3.26; 95% CI 1.95-5.46; P< 0.00001); waist-hip ratio (first vs second tertile) (OR=3.07; 95% CI 1.66-5.66; P=0.0003); LDL-cholesterol level (OR=2.75; 95% CI 1.45-5.19; P=0.0018); antecedents of diabetes mellitus (OR= 2.51; 95% CI 1.45-5.19; P=0.023); family history of coronary artery disease (OR=2.33; 95% CI 1.44-3.75; P=0.0005); and HDL-cholesterol level (OR=0.53; 95% CI 0.32-0.87; P=0.011). CONCLUSION: Smoking, waist-hip ratio, antecedents of arterial hypertension and of diabetes mellitus, family history of coronary artery disease, and LDL-cholesterol and HDL-cholesterol levels showed to be independently associated with AMI within the São Paulo metropolitan region.