Association of psychosocial risk factors with risk of acute myocardial infarction in 11 119 cases and 13 648 controls from 52 countries (the INTERHEART study): case-control study
Abstract
Background Psychosocial factors have been reported to be independently associated with coronary heart disease. However, previous studies have been in mainly North American or European populations. The aim of the present analysis was to investigate the relation of psychosocial factors to risk of myocardial infarction in 24767 people from 52 countries.Methods We used a case-control design with 11119 patients with a first myocardial infarction and 13648 age-matched (up to 5 years older or younger) and sex-matched controls from 262 centres in Asia, Europe, the Middle East, Africa, Australia, and North and South America. Data for demographic factors, education, income, and cardiovascular risk factors were obtained by standardised approaches. Psychosocial stress was assessed by four simple questions about stress at work and at home, financial stress, and major life events in the past year. Additional questions assessed locus of control and presence of depression.Findings People with myocardial infarction (cases) reported higher prevalence of all four stress factors (p<0.0001). Of those cases still working, 23.0% (n=1249) experienced several periods of work stress compared with 17.9% (1324) of controls, and 10.0% (540) experienced permanent work stress during the previous year versus 5.0% (372) of controls. Odds ratios were 1.38 (99% CI 1.19-1.61) for several periods of work stress and 2.14 (1.73-2.64) for permanent stress at work, adjusted for age, sex, geographic region, and smoking. 11.6% (1288) of cases had several periods of stress at home compared with 8.6% (1179) of controls (odds ratio 1.52 [99% CI 1.34-1.72]), and 3.5% (384) of cases reported permanent stress at home versus 1.9% (253) of controls (2.12 [1.68-2.65]). General stress (work, home, or both) was associated with an odds ratio of 1.45 (99% CI 1.30-1.61) for several periods and 2.17 (1.84-2.55) for permanent stress. Severe financial stress was more typical in cases than controls (14.6% [1622] vs 12.2% [1659]; odds ratio 1.33 [99% CI 1.19-1.48]). Stressful life events in the past year were also more frequent in cases than controls (16.1% [1790] vs 13.0% [1771]; 1.48 [1.33-1.64]), as was depression (24.0% [2673] vs 17.6% [2404]; odds ratio 1.55 [1.42-1.69]). These differences were consistent across regions, in different ethnic groups, and in men and women.Interpretation Presence of psychosocial stressors is associated with increased risk of acute myocardial infarction, suggesting that approaches aimed at modifying these factors should be developed.
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Long-term stress increases the number of psychological difficulties and causes physical impairment.
“There is considerable evidence that long-term stress increases the number of psychological difficulties and causes physical impairment [2–5].”
People suffering from the stressor of financial debt carry an increased risk for disease.
“For example, people suffering from the stressor of financial debt carry an increased risk for disease (Rosengren et al., 2004).”
From Exposed to events that never happen: generalized unsafety, the default stress response, and prolonged autonomic activity (2017) · cites this paper as Rosengren et al., 2004
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- Authors
- Rosengren, A., Hawken, S., Ôunpuu, S., Sliwa, K., Zubaid, M., Almahmeed, W. A., Blackett, K. N., Sitthi-amorn, C., Sato, H., & Yusuf, S.
- Affiliations
- Sahlgrenska University Hospital (SE)
- Hamilton Health Sciences (CA)
- Chris Hani Baragwanath Hospital (ZA)
- Kuwait University (KW)
- University Teaching Hospital of Yaounde (CM)
- The University of Osaka (JP)
- Corresponding author
- Yusuf, Salim
- ORCID
- Venue
- The Lancet
- Publisher
- Elsevier BV
- Published
- 2004-09
- Volume
- 364
- Issue
- 9438
- Pages
- 953-962
- ISSN
- 0099-5355 (ISSN-L)
- 0140-6736
- OpenAlex
- W1998234914
- Cited by
- 2,414
- References
- 40
- Citations by year
- 2026: 74 · 2025: 82 · 2024: 106 · 2023: 97 · 2022: 114 · 2021: 119 · 2020: 131 · 2019: 141 · 2018: 132 · 2017: 123 · 2016: 123 · 2015: 129 · 2014: 120 · 2013: 121 · 2012: 123
- FWCI
- 48.00
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- The Lancet (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Health and Mental Health
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Health and Risk Factors
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Acute Myocardial Infarction Research
- Keywords
- acute myocardial infarction, psychosocial risk factors, psychosocial stress, occupational stress, home stress, financial stress, major life events, locus of control, depression, coronary artery disease, cardiovascular risk factors, INTERHEART study, cross-national comparison, income, smoking, alcohol consumption, physical activity, diet, diabetes mellitus, hypercholesterolemia
- MeSH terms
- Cross-Cultural Comparison, Depression, Female, Humans, Internal-External Control, Male, Middle Aged, Myocardial Infarction, Risk Factors, Socioeconomic Factors, Stress, Psychological, Odds Ratio, Case-Control Studies
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