INTERHEART Study Research Articles

Stellenwert von Veränderungen der Lebensgewohnheiten zur Risikoreduktion

Cardiovascular risk is substantially influenced by changes in habits. In this context the INTERHEART study showed that a healthy vitamin-packed nutrition and regular workout reduced the cardiovascular risk up to 79%. In this case people older than 50 years would benefit most from change. Patients suffering from obesity should combine a low-calory diet with physical training in order to reduce weight. Here optimal results can be achieved by considering intensity as well as quantity for each patient.

Tobacco use and risk of myocardial infarction in 52 countries in the INTERHEART study: a case-control study

Tobacco use is one of the major avoidable causes of cardiovascular diseases. We aimed to assess the risks associated with tobacco use (both smoking and non-smoking) and second hand tobacco smoke (SHS) worldwide. We did a standardised case-control study of acute myocardial infarction (AMI) with 27,089 participants in 52 countries (12,461 cases, 14,637 controls). We assessed relation between risk of AMI and current or former smoking, type of tobacco, amount smoked, effect of smokeless tobacco, and exposure to SHS. We controlled for confounders such as differences in lifestyles between smokers and non-smokers. Current smoking was associated with a greater risk of non-fatal AMI (odds ratio [OR] 2.95, 95% CI 2.77-3.14, p<0.0001) compared with never smoking; risk increased by 5.6% for every additional cigarette smoked. The OR associated with former smoking fell to 1.87 (95% CI 1.55-2.24) within 3 years of quitting. A residual excess risk remained 20 or more years after quitting (1.22, 1.09-1.37). Exclusion of individuals exposed to SHS in the never smoker reference group raised the risk in former smokers by about 10%. Smoking beedies alone (indigenous to South Asia) was associated with increased risk (2.89, 2.11-3.96) similar to that associated with cigarette smoking. Chewing tobacco alone was associated with OR 2.23 (1.41-3.52), and smokers who also chewed tobacco had the highest increase in risk (4.09, 2.98-5.61). SHS was associated with a graded increase in risk related to exposure; OR was 1.24 (1.17-1.32) in individuals who were least exposed (1-7 h per week) and 1.62 (1.45-1.81) in people who were most exposed (>21 h per week). Young male current smokers had the highest population attributable risk (58.3%; 95% CI 55.0-61.6) and older women the lowest (6.2%, 4.1-9.2). Population attributable risk for exposure to SHS for more than 1 h per week in never smokers was 15.4% (12.1-19.3). Tobacco use is one of the most important causes of AMI globally, especially in men. All forms of tobacco use, including different types of smoking and chewing tobacco and inhalation of SHS, should be discouraged to prevent cardiovascular diseases.

South Asians and Cardiovascular Risk

Case presentation: A 36-year-old nonsmoking, normotensive South Asian man presented to the emergency department of a community hospital with retrosternal chest pain of &60 minutes’ duration. His 12-lead ECG demonstrated 10 mm of ST-segment elevation in leads V2 through V6, and he received fibrinolytic therapy within 90 minutes of symptom onset. His pain resolved, but his ST segments only partially normalized; he had a peak creatine kinase of 4564 IU/L, and he showed signs of early heart failure. LDL cholesterol was 135 mg/dL, HDL 32 mg/dL, triglycerides 20 mg/dL, and total cholesterol 206 mg/dL; his body mass index (BMI) was 24 kg/m2. Cardiac catheterization demonstrated severe and diffuse triple-vessel disease, including occlusion of the proximal left anterior descending artery, as well as moderate left ventricular dysfunction. While in the hospital, he was diagnosed with new-onset type 2 diabetes mellitus and subsequently underwent uncomplicated coronary bypass surgery. South Asians are individuals whose ethnic roots originate from the Indian subcontinent, a large geographic area that includes India, Pakistan, Sri Lanka, Nepal, and Bangladesh. Collectively, South Asians represent one fifth of the global population. In North America, more than 2 million South Asians reside in the United States and almost 1 million in Canada. It is important to recognize that the term “South Asian” refers to a heterogeneous population, with important differences in diet, culture, and lifestyle among different South Asian populations and religions. Multiple studies of migrant South Asian populations have, however, confirmed a 3- to 5-fold increase in the risk for myocardial infarction and cardiovascular death as compared with other ethnic groups.1–3 In an analysis of age-standardized coronary heart disease (CHD) mortality in Canada over a 15-year period, South Asians had the highest CHD mortality compared with individuals of Chinese and European descent.4 In …

The role of peroxiredoxins in ischemia-reperfusion-induced cardiac damage

myocardial ischemia related to infarction is a disease of multiple pathways with variable outcomes. Both ischemia and reperfusion contribute to cell and tissue damage after cardiac infarction. Myocardial ischemia-reperfusion initiates maldistribution of ions and various signaling mechanisms, leading

Primary prevention of ischaemic heart disease

Abstract Cardiovascular disease (CVD) remains the leading cause of global morbidity and mortality causing over 4 million deaths in Europe and 17 million deaths worldwide in 1999. Coronary heart disease (CHD) is the primary killer of Americans, accounting for 1 in 5 deaths in 2000. Abnormal lipids, smoking, hypertension, diabetes, abdominal obesity, psychosocial factors, low consumption of fruit and vegetables, no alcohol intakes and irregular physical exercise account for more than 90% of the risk of an acute myocardial infarction (MI) across age groups and in all regions of the world, according to the recent INTERHEART study. Since cardiovascular disease (CVD) is therefore a multi-factorial syndrome, guidelines need to identify risk ands provide preventative and treatment goals, whilst remaining simple to interpret and implement. The National Cholesterol Education Program (NCEP), Adult Treatment Panel (ATP) III guidelines and the Third Joint Task Force of European Societies guidelines both recognise the importance of dyslipideamia, hypertension and smoking as the main risk factors for CVD, advocate risk assessment based on the Framingham Algorithm to determine those eligible for primary prevention, and the role of lifestyle changes, statin and anti-hypertensive therapies as the most evidence-based interventions.

Early intervention and prevention of myocardial infarction

Although there has been a decline in the incidence of ischaemic heart disease in Western Europe, North America and Australia/New Zealand, it remains a major cause of morbidity and mortality worldwide due to rapidly increasing incidences in developing countries. Prevention is key to reducing the burden of this disease. The INTERHEART study performed in 52 countries around the world has shown that the major risk factors are tobacco smoking, elevated apolipoprotein A, hypertension, diabetes mellitus, abdominal obesity, psychosocial factors, low fruit and vegetable intake, physical inactivity and alcohol consumption. Strategies for prevention by reducing risk factors are applicable universally. Individual healthcare providers can implement primary and secondary preventive measures to individual patients. Primary prevention involves the avoidance of disease in high-risk subjects free of disease, whereas the purpose of secondary prevention is to avoid recurrence of myocardial infarction. The general principle is to encourage improved and proven lifestyle measures and to prescribe evidence-based effective medications. Primary prevention requires greater investment and planning to identify people at high risk, plus the implementation of life-style intervention and pharmacological prevention. In both situations, strategies will have to be tailored to suit individual countries and economies. Life-style measures (i.e. sensible diet, physical exercise and smoking cessation) are effective and need to be promoted. Compliance with preventive measures is achievable. Primordial prevention, which involves reducing the prevalence of risk factors, rests mainly on public education, media, legislation and government policy, and is very dependent on individual governments' commitment and determination. It requires promoting a healthier life-style in the population as a whole by encouraging people to seek alternatives and making them available.

Behavioral cardiology: Recognizing and addressing the profound impact of psychosocial stress on cardiovascular health

Psychosocial stress exerts independent adverse effects on cardiovascular health. The recent INTERHEART study reported that psychosocial stress accounted for approximately 30% of the attributable risk of acute myocardial infarction. Prospective studies consistently indicate that hostility, depression, and anxiety are all related to increased risk of coronary heart disease and cardiovascular death. A sense of hopelessness, in particular, appears to be strongly correlated with adverse cardiovascular outcomes. Time urgency and impatience have not been consistently related to risk of coronary disease, but do increase the likelihood of developing hypertension. Psychosocial stress appears to adversely affect autonomic and hormonal homeostasis, resulting in metabolic abnormalities, inflammation, insulin resistance, and endothelial dysfunction. Additionally, stress is often associated with self-destructive behavior and noncompliance with medications. Psychosocial stress is a highly modifiable risk and many factors have been shown to be protective. These include psychosocial support, regular exercise, stress reduction training, sense of humor, optimism, altruism, faith, and pet ownership. Simple screening questions are available to reliably indicate a patient at risk for psychosocial stress-related health problems.

What’s the Best Measure of Obesity?

The multinational INTERHEART study identified abdominal obesity and eight other modifiable risk factors as accounting for 90% of MIs worldwide (Journal

Risk Factors Associated With Myocardial Infarction in Africa

Cardiovascular disease (CVD) is rising in low-income countries. However, the impact of modifiable CVD risk factors on myocardial infarction (MI) has not been studied in sub-Saharan Africa (SSA). Therefore, we conducted a case-control study among patients with acute MI (AMI) in SSA to explore its association with known CVD risk factors. First-time AMI patients (n=578) were matched to 785 controls by age and sex in 9 SSA countries, with South Africa contributing approximately 80% of the participants. The relationships between risk factors and AMI were investigated in the African population and in 3 ethnic subgroups (black, colored, and European/other Africans) and compared with those found in the overall INTERHEART study. Relationships between common CVD risk factors and AMI were found to be similar to those in the overall INTERHEART study. Modeling of 5 risk factors (smoking history, diabetes history, hypertension history, abdominal obesity, and ratio of apolipoprotein B to apolipoprotein A-1) provided a population attributable risk of 89.2% for AMI. The risk for AMI increased with higher income and education in the black African group in contrast to findings in the other African groups. A history of hypertension revealed higher MI risk in the black African group than in the overall INTERHEART group. Known CVD risk factors account for approximately 90% of MI observed in African populations, which is consistent with the overall INTERHEART study. Contrasting gradients found in socioeconomic class, risk factor patterns, and AMI risk in the ethnic groups suggest that they are at different stages of the epidemiological transition.

Issue Highlights

HomeCirculationVol. 112, No. 23Issue Highlights Free AccessIn BriefPDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessIn BriefPDF/EPUBIssue Highlights Originally published6 Dec 2005https://doi.org/10.1161/circ.112.23.3535Circulation. 2005;112:3535RISK FACTORS ASSOCIATED WITH MYOCARDIAL INFARCTION IN AFRICA: THE INTERHEART AFRICA STUDY, by Steyn et al.The data presented by Steyn et al are from the INTERHEART case-control study in 9 sub-Saharan African countries. This study shows, for the first time, what the impact is of modifiable cardiovascular disease (CVD) risk factors on acute myocardial infarctions (AMI). Patients (n=578) were matched to 789 controls. Similar relationships between common CVD risk factors and AMI were found as in the overall INTERHEART study. Modeling of 5 risk factors (smoking, self-reported diabetes and hypertension history, abdominal obesity, and apoB:apoA1 ratio) provided a population-attributable risk of 89.2% for AMI. Four of these risk factors can be determined by taking a medical history and simply measuring the waist and hip circumferences. Contrasting gradients found in socioeconomic class, risk factors, and AMI risk when comparing ethnic subgroups (black, colored, and European/other Africans) suggest different stages of the epidemiological transition. This suggests that AMI will increase in the future in sub-Saharan Africa unless primordial prevention of CVD risk factors occurs, as well as early diagnoses and effective treatment of those with CVD risk factors. See p 3554.EPIDEMIOLOGY AND ETIOLOGY OF CARDIOMYOPATHY IN AFRICA, by Sliwa et al.Cardiomyopathy has been known to be endemic in sub-Saharan Africa for nearly a century. The leading causes of heart failure in sub-Saharan Africa are hypertension, valvular heart disease, and cardiomyopathy. This is in contrast to other regions of the world where heart failure is commonly caused by ischemic heart disease. Sliwa and colleagues provide the most comprehensive review to date of what is known about the causes and determinants of heart muscle disease in Africa. They highlight the importance of peripartum cardiomyopathy, which has a frequency as high as 1 in 100 mothers giving birth in parts of Nigeria. Endomyocardial fibrosis is a unique and debilitating form of tropical heart muscle disease that may be found in up to 8% of the population in parts of Mozambique. The authors call for renewed efforts to identify the determinants of heart muscle disease through population-based epidemiological research. See p 3577.HYPERTENSION IN SUB-SAHARAN AFRICAN POPULATIONS, by Opie and Seedat.Hypertension is a major problem in the black population of sub-Saharan Africa. The prevalence varies from rural to urban populations. There is a “second wave” epidemic of cardiovascular disease (CVD) that is now flowing through developing countries and the former socialist republics. There are genetic, endocrine, environmental, and renal physiological factors that contribute to hypertension. Sub-Saharan Africa is also burdened with infectious diseases like AIDS, tuberculosis, and malaria, in addition to diseases of lifestyle such as hypertension. The prevention of cardiovascular diseases presents a challenge. Strategies to prevent the acquisition or enhancement of CVD risk factors (primordial prevention) must be combined to reverse or reduce risk factors, which include changes in lifestyle and diet brought about by rapid urbanization. The approach should be nonpharmacological, population based, and lifestyle linked. This would obviate the biological and economic costs of a pharmacological approach. There also is a need to develop cost-effective methods for the diagnosis and low-cost measures for all the risk factors of cardiovascular disease. Although tertiary care is growing, the pattern should be optimization of resources and the avoidance of high-cost, low-yield technologies. See p 3562.Visit http://www.circ.ahajournals.org:Images in Cardiovascular MedicineMultislice Computed Tomography and Magnetic Resonance Imaging: Complementary Use in Noninvasive Coronary Angiography. See p e343.Optical Coherence Tomography Findings at 5-Year Follow-Up After Coronary Stent Implantation. See p e345. Download figureDownload PowerPointSubaortic Membrane in the Adult. See p e347.CorrespondenceSee p e348. Previous Back to top Next FiguresReferencesRelatedDetails December 6, 2005Vol 112, Issue 23 Advertisement Article InformationMetrics https://doi.org/10.1161/circ.112.23.3535 Originally publishedDecember 6, 2005 PDF download Advertisement

Obesity management: the cardiovascular benefits

The latest data from the International Obesity TaskForce show a marked trend towards increasing levels of adult overweight and obesity throughout Europe. Obesity rates range from 10–27% in men and up to 38% in women. In parts of Europe, the combination of reported overweight and obesity in men exceeds even the 67% prevalence found in the USA's most recent measured survey. At least nine European countries have male obesity rates above 20% while in at least seven countries, one in five women is obese. Major health threats associated with overweight and obesity include dyslipidaemia, metabolic syndrome, Type 2 diabetes, and cardiovascular diseases. The recently published INTERHEART study identified nine modifiable risk factors that account for 90% of acute myocardial infarctions globally, across all age groups and races. Importantly, seven …

STRESS, TRAUMA, AND CORONARY HEART DISEASE AMONG NATIVE AMERICANS

In the May 2005 issue, which focused on Native Americans/Alaska Natives, we were especially interested in the article by the American Indian Service Utilization, Psychiatric Epidemiology, Risk and Protective Factors Project (AI-SUPERPFP) Team, “Social Epidemiology of Trauma Among 2 American Indian Reservation Populations.”1 This study quantified exposure to trauma among American Indians, adding to the existing evidence2,3 that this population experiences a disproportional amount of trauma. We were intrigued by the statement “It may be that high rates of trauma exposure contribute to the increasing prevalence of cardiovascular disease among American Indian men and women, the leading cause of death among this population”1(p858) and wanted to lend support to this assertion. Indeed, American Indians now have the highest rates of cardiovascular disease in the United States.4 In a study similar to the AI-SUPERPFP study, Koss et al.5 documented adverse childhood exposures among 7 Native American tribes and compared these exposures to levels observed in the Adverse Childhood Experiences (ACE) Study conducted by Kaiser Permanente and the Centers for Disease Control and Prevention in a health maintenance organization population. Compared with participants in the ACE study, not only did the American Indians have a significantly higher rate of exposure to any trauma (86% vs 52%), but they also had a more than 5-fold risk of having been exposed to 4 or more categories of adverse childhood experiences (33% vs 6.2%). We know from the ACE study that there is a linear, dose–response relationship between the number of adverse childhood experiences and not only coronary heart disease (CHD) risk factors such as cigarette smoking6 but also the occurrence of ischemic heart disease.7 The INTERHEART study8 found that large traumatic exposures were associated with increased risk of myocardial infarction and, further, that current or recent psychosocial stress alone resulted in a population attributable risk of 33% for myocardial infarction. Because 1 of the 2 most important risk factors in the INTERHEART study was smoking, and because there is a strong association between cigarette smoking and psychosocial stress, psychosocial stress may contribute even more strongly to CHD risk than even this high population-attributable risk would indicate. We are indebted to studies such as these for helping to answer the myriad questions associated with the relationship between stress and trauma and CHD risk. Such research allows those of us in clinical and academic medicine to turn our attention to the challenge of developing interventions to mitigate the health effects associated with traumatic life experiences.

Coronary Artery Surgery

Coronary Artery Surgery

Psychosocial Risk Factors for Acute Myocardial Infarction

Rosengren A, Hawken S, Ounpuru S, Sliwa K, Zubaid M, Almahmeed WA, Blackett KN, Sitthi-amorn C, Sato H, Yusuf S, for the INTERHEART investigators: Association of psyhcosocial risk factors with risk of acute myocardial infarction in 11,119 cases and 13, 648 controls from 52 countries (the INTERHEART Study): case-control study. Lancet 364:953 -962, 2004 [OpenUrl][1][CrossRef][2][PubMed][3][Web of Science][4] Objective. To investigate the relation of psychosocial factors to the risk of myocardial infarction (MI). Design. A case-control study including 11,119 patients with a first MI and 13,648 age- and sex-matched control subjects. Setting. Two hundred and sixty-two centers in Asia, Europe, the Middle East, Africa, Australia, and North and South America. Exposure. Psychosocial stress was assessed by four simple questions about stress at work and at home, financial stress, and major life events in the past year. Additional questions assessed locus of control and presence of depression. End points. Adjusted odds ratios for association with first MI. Results. Controlled for confounders, people with MI reported higher prevalence of all four stress … [1]: {openurl}?query=rft.jtitle%253DLancet%26rft.stitle%253DLancet%26rft.aulast%253DRosengren%26rft.auinit1%253DA.%26rft.volume%253D364%26rft.issue%253D9438%26rft.spage%253D953%26rft.epage%253D962%26rft.atitle%253DAssociation%2Bof%2Bpsychosocial%2Brisk%2Bfactors%2Bwith%2Brisk%2Bof%2Bacute%2Bmyocardial%2Binfarction%2Bin%2B11119%2Bcases%2Band%2B13648%2Bcontrols%2Bfrom%2B52%2Bcountries%2B%2528the%2BINTERHEART%2Bstudy%2529%253A%2Bcase-control%2Bstudy.%26rft_id%253Dinfo%253Adoi%252F10.1016%252FS0140-6736%252804%252917019-0%26rft_id%253Dinfo%253Apmid%252F15364186%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx [2]: /lookup/external-ref?access_num=10.1016/S0140-6736(04)17019-0&link_type=DOI [3]: /lookup/external-ref?access_num=15364186&link_type=MED&atom=%2Fdiaclin%2F23%2F1%2F35.atom [4]: /lookup/external-ref?access_num=000223831000025&link_type=ISI

Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): Case-control study

Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): Case-control study

Association of psychosocial risk factors with risk of acute myocardial infarction in 11 119 cases and 13 648 controls from 52 countries (the INTERHEART study): case-control study

Psychosocial factors have been reported to be independently associated with coronary heart disease. However, previous studies have been in mainly North American or European populations. The aim of the present analysis was to investigate the relation of psychosocial factors to risk of myocardial infarction in 24767 people from 52 countries. We used a case-control design with 11119 patients with a first myocardial infarction and 13648 age-matched (up to 5 years older or younger) and sex-matched controls from 262 centres in Asia, Europe, the Middle East, Africa, Australia, and North and South America. Data for demographic factors, education, income, and cardiovascular risk factors were obtained by standardised approaches. Psychosocial stress was assessed by four simple questions about stress at work and at home, financial stress, and major life events in the past year. Additional questions assessed locus of control and presence of depression. People with myocardial infarction (cases) reported higher prevalence of all four stress factors (p<0.0001). Of those cases still working, 23.0% (n=1249) experienced several periods of work stress compared with 17.9% (1324) of controls, and 10.0% (540) experienced permanent work stress during the previous year versus 5.0% (372) of controls. Odds ratios were 1.38 (99% CI 1.19-1.61) for several periods of work stress and 2.14 (1.73-2.64) for permanent stress at work, adjusted for age, sex, geographic region, and smoking. 11.6% (1288) of cases had several periods of stress at home compared with 8.6% (1179) of controls (odds ratio 1.52 [99% CI 1.34-1.72]), and 3.5% (384) of cases reported permanent stress at home versus 1.9% (253) of controls (2.12 [1.68-2.65]). General stress (work, home, or both) was associated with an odds ratio of 1.45 (99% CI 1.30-1.61) for several periods and 2.17 (1.84-2.55) for permanent stress. Severe financial stress was more typical in cases than controls (14.6% [1622] vs 12.2% [1659]; odds ratio 1.33 [99% CI 1.19-1.48]). Stressful life events in the past year were also more frequent in cases than controls (16.1% [1790] vs 13.0% [1771]; 1.48 [1.33-1.64]), as was depression (24.0% [2673] vs 17.6% [2404]; odds ratio 1.55 [1.42-1.69]). These differences were consistent across regions, in different ethnic groups, and in men and women. Presence of psychosocial stressors is associated with increased risk of acute myocardial infarction, suggesting that approaches aimed at modifying these factors should be developed.

Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): case-control study

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. 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. 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. 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.