A population-based case-referent study of myocardial infarction and occupational exposure to motor exhaust, other combustion products, organic solvents, lead, and dynamite. Stockholm Heart Epidemiology Program (SHEEP) Study Group

Epidemiology. 2001 Mar;12(2):222-8. doi: 10.1097/00001648-200103000-00015.


This case-referent study investigated the risk of myocardial infarction from occupational exposure to motor exhaust, other combustion products, organic solvents, lead, and dynamite. We identified first-time, nonfatal myocardial infarctions among men and women 45-70 years of age in Stockholm County from 1992 through 1994. We selected referent subjects from the population to match the demographic characteristics of the cases. A lifetime history of occupations was obtained by questionnaire. The response rate was 81% for the cases and 74% for the referents, with 1,335 cases and 1,658 referents included in the study. An occupational hygienist assessed occupational exposures, coding the intensity and probability of exposure for each subject. We adjusted relative risk estimates for tobacco smoking, alcohol drinking, hypertension, diabetes mellitus, overweight, and physical inactivity at leisure time. The relative risk of myocardial infarction was 2.11 (95% confidence interval = 1.23-3.60) among those who were highly exposed and 1.42 (95% confidence interval = 1.05-1.92) among those who were intermediately exposed to combustion products from organic material. We observed an exposure-response pattern, in terms of both maximum exposure intensity and cumulative dose. Exposure to dynamite and organic solvents was possibly associated with an increased risk. The other exposures were not consistently associated with myocardial infarction.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Air Pollutants, Occupational / adverse effects*
  • Case-Control Studies
  • Female
  • Humans
  • Lead / adverse effects*
  • Male
  • Middle Aged
  • Myocardial Infarction / epidemiology
  • Myocardial Infarction / etiology*
  • Nitroglycerin / adverse effects*
  • Occupational Diseases / epidemiology
  • Occupational Diseases / etiology*
  • Occupational Exposure / adverse effects*
  • Occupations
  • Polycyclic Aromatic Hydrocarbons / adverse effects*
  • Risk Factors
  • Solvents / adverse effects
  • Surveys and Questionnaires
  • Sweden / epidemiology
  • Vehicle Emissions / adverse effects*


  • Air Pollutants, Occupational
  • Polycyclic Aromatic Hydrocarbons
  • Solvents
  • Vehicle Emissions
  • Lead
  • Nitroglycerin