Potentially modifiable classic risk factors and their impact on incident myocardial infarction: results from the EPIC-Potsdam study

Background Prospective data on the importance of established risk factors for myocardial infarction in Germany are sparse. Design The population-based cohort study European Prospective Investigation into Cancer and Nutrition (EPIC)-Potsdam with 159 incident cases of myocardial infarction (120 men, 39 women) occurring among 26 954 participants (10 463 men, 16491 women) during an average follow-up time of 4.6 years. Methods We examined the classic, potentially modifiable risk factors smoking, hypertension, hyperlipidemia, diabetes mellitus, abdominal obesity, and sporting inactivity, both individually and in combination, by estimating their prevalence and their relative and population-attributable risks of incident myocardial infarction. Results After adjusting for age, sex, educational attainment, alcohol intake, and the respective other classic risk factors the relative risks of myocardial infarction were 3.18 for smoking [95% confidence interval (CI) 2.31, 4.38], 1.84 for hypertension (95% Cl 1.27, 2.65), 1.81 for sporting inactivity (95% Cl 1.04, 3.15), 1.64 for diabetes (95% Cl 1.05, 2.56), 1.62 for abdominal obesity (95% Cl 1.03, 2.56), and 1.15 for hyperlipidemia (95% Cl 0.84,1.59). Participants with four or all five significant risk factors had an approximately 11.5-fold higher risk of the coronary event than participants with none or one risk factor. Altogether, 84.3% of myocardial infarctions in the study population were attributable to the presence of the five risk factors smoking, hypertension, diabetes, sporting inactivity, and abdominal obesity. Conclusion The majority of myocardial infarctions in the EPIC-Potsdam cohort were explainable by potentially modifiable classic risk factors. Therefore, besides efforts to investigate novel coronary risk factors, the prevention of coronary disease should focus on strategies to reduce the prevalence of established risk factors.