Nine Factors Predict Most Heart Attack
90 percent of heart attacks worldwide can be predicted by nine
risk factors, a landmark study has found.
The study has overturned the common perception
that only half of the risk of heart attacks can be accounted
The implications are straightforward: if we
implement what we know today, we should be able to avert the
majority of premature heart disease cases.
Study of acute myocardial infarction (AMI) in
52 countries representing every inhabited continent and enrolled
15, 152 individuals with their first heart attack and 14,820
controls adjusted for age, sex and region. In terms of
ethnicity, about a quarter of the participants were European and
a quarter Chinese.
The top two risk factors were abnormal lipids
(the ratio of apolipoprotein B to apolipoprotein A1) and
Together, they accounted for two-third of the
population attributable risk (PAR) of AMI. Both these factors
also showed a graded dose-response relationship with the odds of
The other risk factors were psychosocial
factors, hypertension, diabetes and abdominal obesity. Eating
fruits and vegetables, regular alcohol consumption in small
amounts and physical activity were protective against AMI. One
of the surprises of the study was how important psychosocial
factors were, psychosocial factors were found to increase the
risk of a heart attack about two and a half times.
Also noted that abdominal obesity was an
important risk factor - even greater than the risk associated
Western Europe, North America, Australia and
New Zealand, and Southeast Asia. However, in countries such as
China where obesity is less prevalent, the risk from obesity was
far less than that associated with smoking.
The median age of first AMI in men was 9 years
younger than in women. Men and women had similar odd ratio for
the risk factors of smoking, raised lipids, abdominal obesity,
psychosocial factors and fruit and vegetable on consumption.
However the increased risk associated with
diabetes and hypertension and the protective effect of exercise
and alcohol, were greater in women than men.
Comparing the effects of these risk factors
among the young (=55 years for men, =65 year for women) and the
old, the nine risk factors accounted for a significantly greater
PAR in the former.
The study findings underline the message that
a healthy life style matter.
Globally, about 55 to 60 percent of the PAR
can be attributed to an adverse lifestyle. And this is
consistent in every region of the world, and obviously, tobacco
is the biggest culprit.
The study found that eating fruits and
vegetables, taking exercise and avoiding smoking could lower the
risk of a heart attack by about 80 percent. These results are
similar to that of the US Nurses Health Study, which found that
lifestyle modification could potentially avoid more than
three-quarters of the risks of coronary heart disease and
strokes in women.
The risk factors of AMI are strikingly
consistent across age genders, ethnicity and region.