Lesson212


空気汚染が?たばこ?
心筋梗塞の最も重要な誘発因子


文献:Nawrot TS et al.Public health importance of triggers of myocardial infarction: a comparative risk assessment.Lancet 2011;377:732-740.

パブメドおよびウェブ・オブ・サイエンスのデータベースで非致死性の心筋梗塞の誘発因子に関する研究を特定し、人口寄与割合を測定。人口寄与割合をオッズ比と曝露の割合を考慮して測定した結果、空気汚染が心筋梗塞の最も重要な誘発因子(7.4%)と示され、次に重要な因子は身体運動(6.2%)、飲酒(5.0%)、コーヒー(5.0%)だった。

February 2011

Public health importance of triggers of myocardial infarction: a comparative risk assessment

Background
Acute myocardial infarction is triggered by various factors, such as physical exertion, stressful events, heavy meals, or increases in air pollution. However, the importance and relevance of each trigger are uncertain. We compared triggers of myocardial infarction at an individual and population level.

Methods

We searched PubMed and the Web of Science citation databases to identify studies of triggers of non-fatal myocardial infarction to calculate population attributable fractions (PAF). When feasible, we did a meta-regression analysis for studies of the same trigger.

Findings

Of the epidemiologic studies reviewed, 36 provided sufficient details to be considered. In the studied populations, the exposure prevalence for triggers in the relevant control time window ranged from 0・04% for cocaine use to 100% for air pollution. The reported odds ratios (OR) ranged from 1・05 to 23・7. Ranking triggers from the highest to the lowest OR resulted in the following order: use of cocaine, heavy meal, smoking of marijuana, negative emotions, physical exertion, positive emotions, anger, sexual activity, traffic exposure, respiratory infections, coffee consumption, air pollution (based on a difference of 30 μg/m3 in particulate matter with a diameter <10 μm [PM10]). Taking into account the OR and the prevalences of exposure, the highest PAF was estimated for traffic exposure (7・4%), followed by physical exertion (6・2%), alcohol (5・0%), coffee (5・0%), a difference of 30 μg/m3 in PM10 (4・8%), negative emotions (3・9%), anger (3・1%), heavy meal (2・7%), positive emotions (2・4%), sexual activity (2・2%), cocaine use (0・9%), marijuana smoking (0・8%) and respiratory infections (0・6%).

Interpretation

In view of both the magnitude of the risk and the prevalence in the population, air pollution is an important trigger of myocardial infarction, it is of similar magnitude (PAF 5-7%) as other well accepted triggers such as physical exertion, alcohol, and coffee. Our work shows that ever-present small risks might have considerable public health relevance.

Funding

The research on air pollution and health at Hasselt University is supported by a grant from the Flemish Scientific Fund (FWO, Krediet aan navorsers/G.0873.11), tUL-impulse financing, and bijzonder onderzoeksfonds (BOF) and at the Katholieke Universiteit Leuven by the sustainable development programme of BELSPO (Belgian Science Policy).

(2011年2月28日 提供:m3.com)