Effect of Potentially Modifiable Risk Factors Associated With Myocardial Infarction in 52 Countries (The Interheart Study)

Case-control study

Bibliographic Data

ID23318409
AuthorsSemir Yusuf (0000-0003-4776-5601, Hamilton General Hospital, corresponding author), Salim Yusuf, Steven Hawken (0000-0002-3341-9022, Hamilton General Hospital), Stephanie Ôunpuu (Hamilton General Hospital), Tony Dans (Hamilton General Hospital), Alvaro Avezum (0000-0002-3073-6890, Hamilton General Hospital), Fernando Laņas (0000-0003-3595-9759, Hamilton General Hospital), Matthew Mcqueen (0000-0002-1251-1751, Hamilton General Hospital), Andrzej Budaj (0000-0002-6395-2098, Hamilton General Hospital), Prem Pais (0000-0001-5985-3137, Hamilton General Hospital), John Varigos, George Varigos (0000-0001-6722-3135, Hamilton General Hospital), Liu Lisheng (Hamilton General Hospital)
Year2004
Volume364
Issue9438
Pages937-952
Publication date2004-09-01
Peer ReviewedYes
Open AccessYes
TypeARTICLE
VenueThe Lancet (JOURNAL)
Journal identifiersISSN: 0099-5355 • E-ISSN: 0140-6736
PublisherElsevier BV (PUBLISHER)
DOI10.1016/s0140-6736(04)17018-9
PMID15364185
OpenAlexW2155121555
LanguageEN
Citations received383
References cited27

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.

Abdominal obesity · Cardiology · Diabetes mellitus · Environmental health · Family history · Myocardial infarction · Obesity · Odds ratio · Population · Risk factor · Waist · Acute Myocardial Infarction Research · Cardiovascular Health and Risk Factors · Demography · Diabetes, Cardiovascular Risks, and Lipoproteins · Endocrinology · Internal Medicine · Medicine