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17 août 2016



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.

Références :

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.
Lancet. 2004 Sep 11-17 ; 364(9438):937-52. 15364185

Obesity and the risk of myocardial infarction in 27,000 participants from 52 countries : a case-control study.
Yusuf S, Hawken S, Ounpuu S, Bautista L, Franzosi MG, Commerford P, Lang CC, Rumboldt Z, Onen CL, Lisheng L, Tanomsup S, Wangai P Jr, Razak F, Sharma AM, Anand SS ; INTERHEART Study Investigators.
Lancet. 2005 Nov 5 ; 366(9497):1640-9. 16271645

Lipids, lipoproteins, and apolipoproteins as risk markers of myocardial infarction in 52 countries (the INTERHEART study) : a case-control study.
McQueen MJ, Hawken S, Wang X, Ounpuu S, Sniderman A, Probstfield J, Steyn K, Sanderson JE, Hasani M, Volkova E, Kazmi K, Yusuf S ; INTERHEART study investigators.
Lancet. 2008 Jul 19 ; 372(9634):224-33. 18640459

Risk factors for myocardial infarction in women and men : insights from the INTERHEART study.
Anand SS, Islam S, Rosengren A, Franzosi MG, Steyn K, Yusufali AH, Keltai M, Diaz R, Rangarajan S, Yusuf S ; INTERHEART Investigators.
Eur Heart J. 2008 Apr ; 29(7):932-40. 18334475

Parental history and myocardial infarction risk across the world : the INTERHEART Study.
Chow CK, Islam S, Bautista L, Rumboldt Z, Yusufali A, Xie C, Anand SS, Engert JC, Rangarajan S, Yusuf S.
J Am Coll Cardiol. 2011 Feb 1 ; 57(5):619-27. 21272754

Estimating modifiable coronary heart disease risk in multiple regions of the world : the INTERHEART Modifiable Risk Score.
McGorrian C, Yusuf S, Islam S, Jung H, Rangarajan S, Avezum A, Prabhakaran D, Almahmeed W, Rumboldt Z, Budaj A, Dans AL, Gerstein HC, Teo K, Anand SS ; INTERHEART Investigators.
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Dysglycaemia and the risk of acute myocardial infarction in multiple ethnic groups : an analysis of 15,780 patients from the INTERHEART study.
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Metabolic syndrome and risk of acute myocardial infarction a case-control study of 26,903 subjects from 52 countries.
Mente A, Yusuf S, Islam S, McQueen MJ, Tanomsup S, Onen CL, Rangarajan S, Gerstein HC, Anand SS ; INTERHEART Investigators.
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Leong DP?, Smyth A, Teo KK, McKee M, Rangarajan S, Pais P, Liu L, Anand SS, Yusuf S ; INTERHEART Investigators. Patterns of alcohol consumption and myocardial infarction risk : observations from 52 countries in the INTERHEART case-control study. Circulation. 2014 Jul 29 ; 130(5):390-8. 24928682