Open Access Highly Accessed Research article

Smoking, alcohol consumption, physical activity, and family history and the risks of acute myocardial infarction and unstable angina pectoris: a prospective cohort study

Audrey HH Merry1*, Jolanda MA Boer2, Leo J Schouten3, Edith JM Feskens4, WM Monique Verschuren2, Anton PM Gorgels5 and Piet A van den Brandt13

Author Affiliations

1 Department of Epidemiology, CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, the Netherlands

2 National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands

3 Department of Epidemiology, GROW-School for Oncology and Developmental Biology, Maastricht University, Maastricht, the Netherlands

4 Division of Human Nutrition, Wageningen University, Wageningen, the Netherlands

5 Department of Cardiology, University Hospital Maastricht, Maastricht, the Netherlands

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BMC Cardiovascular Disorders 2011, 11:13  doi:10.1186/1471-2261-11-13

Published: 24 March 2011



Few studies investigated the association between smoking, alcohol consumption, or physical activity and the risk of unstable angina pectoris (UAP), while the strength of these associations may differ compared to other coronary diseases such as acute myocardial infarction (AMI). Therefore, we investigated whether the associations of these lifestyle factors with UAP differed from those with AMI. Additionally, we investigated whether these effects differed between subjects with and without a family history of myocardial infarction (MI).


The CAREMA study consists of 21,148 persons, aged 20-59 years at baseline and randomly sampled from the Maastricht region in 1987-1997. At baseline, all participants completed a self-administered questionnaire. After follow-up of maximally 16.9 years, 420 AMI and 274 UAP incident cases were registered. Incidence rate ratios (RRs) were estimated using Cox proportional hazards models.


For both diseases, smoking increased the risk while alcohol consumption was associated with a protective effect. Associations with both risk factors were stronger for AMI than UAP, although this difference was only statistically significant for smoking. In men, an inverse association was found with physical activity during leisure time which seemed to be stronger for the risk of UAP than of AMI. On the contrary, physical activity during leisure time was associated with an increased risk of both AMI and UAP in women which seemed to be weaker for UAP than for AMI. Except for occupational physical activity in women, no significant interactions on a multiplicative scale were found between the lifestyle factors and family history of MI. Nevertheless, the highest risks were found in subjects with both a positive family history and the most unfavorable level of the lifestyle factors.


The strength of the associations with the lifestyle factors did not differ between AMI and UAP, except for smoking. Furthermore, the effects of the lifestyle factors on the risk of both coronary diseases were similar for subjects with and without a positive family history.