Prof. Simona Giampaoli,
INTERHEART was a standardized case-control study of acute myocardial infarction (AMI) conducted in 52 countries, including 15,152 cases and 14,820 controls. The aim was to examine the relationship of AMI frequency with smoking habit, history of hypertension and diabetes, waist/hip ratio, dietary patterns, physical activity, alcohol consumption, blood apolipoproteins and psychosocial factors. These nine risk factors accounted for 90% of the population attributable risk (PAR) in men and 95% in women. PAR estimates the reduction in incidence if the risk factor were to be eliminated in the population.
Results on associations between AMI and smoking, obesity, diet score, physical activity, ApoB/ApoA1 and low socio economic status were presented. For smoking, there are no doubts, tobacco remains one of the most important cause of AMI (especially in men), and the risk increases with number of cigarettes smoked. Waist/hip ratio seems to be a better indicator of abdominal obesity than BMI and waist alone in predicting AMI. For physical activity, using leisure time, persons were considered physically active if they were involved in moderate (walking, cycling) or strenuous exercise (jogging, football, vigorous swimming). There was an inverse association with moderate physical activity; in cases more hours spent watching TV or using computers. The diet score created using seven food items (meats, fried foods, salty snacks, green leafy vegetables, raw vegetables, cooked vegetables and fruits) was associated with AMI. Education and income were used to evaluate socio economic position, and psychosocial stress was assessed by questions about stress at work, at home, financial stress and life events. In lower socio economic classes, more diseases were accounted; general stress, severe financial stress and life events were more typical in cases than in controls. The association of these risk factors was ere generally stronger in younger individuals, both men and women. The difference in age of AMI was largely explained by the higher levels of risk factors at younger ages in men compared to women.
This study has potential limitations. One is the participants involved, who have survived AMI: by using a case-control design, it is not possible to assess the relation of risk factors in those who died suddenly, before reaching the hospital; but the large number of cases and controls from different regions of the world, across different cultures, as well as the standardized procedures and methods adopted minimized biases. These results reinforce the need for preventive actions at individual and population level.
INTERHEART - an update
This congress report accompanies a presentation given at the ESC Congress 2008. Written by the author himself/herself, this report does not necessarily reflect the opinion of the European Society of Cardiology.
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