Non-traditional risk factors for myocardial infarction in adults under forty: A systematic review of emerging trends

Table 3 Summary table of evidence strength

Risk factor category	Number of studies	Direction of association	Effect estimates (range)	Strength of evidence
Depression/psychosocial	5	Positive (risk ↑)	OR = 1.64-3.09, HR = 1.28-1.31	Strong
Low socioeconomic status	3	Positive (risk ↑)	HR = 1.16-1.47	Moderate
Autoimmune (HIV, SLE)	2	Strong positive (risk ↑)	OR = 2.12-4.06	Strong
Rheumatoid arthritis	1	Negative (risk ↓)	OR = 0.83	Emerging
Telomere length	1	Positive (risk ↑, shorter TL)	T/S ratio 0.115 vs 0.792	Emerging
Obstructive sleep apnea	1	Positive (risk ↑)	HR = 1.55-3.87	Moderate
Mediterranean diet	1	Negative (risk ↓)	OR = 0.55	Moderate
Short sleep duration	1	Positive (risk ↑) (CV health)	OR = 1.38	Emerging
Occupational stress	1	Positive (risk ↑)	5% variance explained	Emerging

Strength of evidence: Strong factors show consistent findings in multiple large studies; moderate factors show consistent findings in ≥ 2 studies or 1 large study; emerging factors show single or small studies, or inconsistent results. OR: Odds ratio; HR: Hazard ratio; HIV: Human immunodeficiency virus; SLE: Systemic lupus erythematosus; TL: Telomere length; T/S: Telomere-to-single-copy gene ratio; CV: Cardiovascular.