Higher relative, but lower absolute risks of myocardial infarction in women than in men: analysis of some major risk factors in the S heep study

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Abstract
Reuterwall C, Hallqvist J, Ahlbom A, de Faire U, Diderichsen F, Hogstedt C, Pershagen G, Theorell T, Wiman B, Wolk A, the S heep Study Group (National Institute for Working Life; Karolinska Institute; Karolinska Hospital; and National Institute for Psychosocial Factors and Health, Solna; and the Stockholm County Council, Stockholm, Sweden). Higher relative, but lower absolute risks of myocardial infarction in women than in men: analysis of some major risk factors in the S heep study. J Intern Med 1999; 246: 161–174. Objectives. Middle-aged men have often been the subjects of multifactorial studies of myocardial infarction (MI) risk factors. One major objective of the S heep study was to compare the effects of different MI risk factors in women and men. Design. S heep (Stockholm Heart Epidemiology Program) is a population-based case-referent study of causes of MI (first event) in Swedish women and men aged 45–70 years. During the period 1992–94, 2246 cases of MI were identified; 34% of the cases were women and 27% of the cases were fatal. One referent per case was chosen randomly from the Stockholm County population after stratification for the case’s sex and age. Logistic regression was used to estimate the relative risks associated with risk factors of primary interest (diabetes, hypercholesterolaemia, hypertriglyceridaemia , hypertension, overweight, physical inactivity, smoking and job strain). Results. The relative risk estimates ranged from 1.5 to 4.4 in women and from 1.3 to 2.9 in men (results for nonfatal cases and their referents). None of the 95% confidence intervals included 1.0. The relative risks were higher in the women than in the men (101–180%). The absolute risks, however, were all lower in the women than in the men. Estimates of Rothman’s synergy index for gender ranged from 1.0 (hypertension) to 1.8 (current smoking). Conclusions. The indications of some effect modification due to sex (stronger risks in men for certain exposures) invoke the question of possible mechanisms.