INTERHEART Study

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Here's the study for the news item a week or so ago which listed the

top ten risk factors for heart attacks. The ideal ApoA1 (HDL) to

ApoB (LDL) ratio is 2:1. From what little information I can find,

ApoA1 does not appear to be the same as lipoprotein(a).

Logan

Effect of potentially modifiable risk factors associated with

myocardial infarction in 52 countries (the INTERHEART study): case-

control study.

Yusuf S, Hawken S, Ounpuu S, Dans T, Avezum A, Lanas F, McQueen M,

Budaj A, Pais P, Varigos J, Lisheng L; INTERHEART Study Investigators.

Population Health Research Institute, Hamilton General Hospital, 237

Barton Street East, Hamilton, Ontario, Canada L8L 2X2.

yusufs@...

Lancet. 2004 Sep 11;364(9438):937-52.

BACKGROUND: Although more than 80% of the global burden of

cardiovascular disease occurs in low-income and middle-income

countries, knowledge of the importance of risk factors is largely

derived from developed countries. Therefore, the effect of such

factors on risk of coronary heart disease in most regions of the

world is unknown. METHODS: We established a standardised case-control

study of acute myocardial infarction in 52 countries, representing

every inhabited continent. 15152 cases and 14820 controls were

enrolled. The relation of smoking, history of hypertension or

diabetes, waist/hip ratio, dietary patterns, physical activity,

consumption of alcohol, blood apolipoproteins (Apo), and psychosocial

factors to myocardial infarction are reported here. Odds ratios and

their 99% CIs for the association of risk factors to myocardial

infarction and their population attributable risks (PAR) were

calculated. FINDINGS: Smoking (odds ratio 2.87 for current vs never,

PAR 35.7% for current and former vs never), raised ApoB/ApoA1 ratio

(3.25 for top vs lowest quintile, PAR 49.2% for top four quintiles vs

lowest quintile), history of hypertension (1.91, PAR 17.9%), diabetes

(2.37, PAR 9.9%), abdominal obesity (1.12 for top vs lowest tertile

and 1.62 for middle vs lowest tertile, PAR 20.1% for top two tertiles

vs lowest tertile), psychosocial factors (2.67, PAR 32.5%), daily

consumption of fruits and vegetables (0.70, PAR 13.7% for lack of

daily consumption), regular alcohol consumption (0.91, PAR 6.7%), and

regular physical activity (0.86, PAR 12.2%), were all significantly

related to acute myocardial infarction (p<0.0001 for all risk factors

and p=0.03 for alcohol). These associations were noted in men and

women, old and young, and in all regions of the world. Collectively,

these nine risk factors accounted for 90% of the PAR in men and 94%

in women. INTERPRETATION: Abnormal lipids, smoking, hypertension,

diabetes, abdominal obesity, psychosocial factors, consumption of

fruits, vegetables, and alcohol, and regular physical activity

account for most of the risk of myocardial infarction worldwide in

both sexes and at all ages in all regions. This finding suggests that

approaches to prevention can be based on similar principles worldwide

and have the potential to prevent most premature cases of myocardial

infarction.