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HEART RISKS 
Leading global risk factors for heart attack:
Risk Factors • Abnormal cholesterol • Eating fruits and vegetables
daily
Source: Interheart Study; Salim Yusuf, McMasters University
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Heart Attacks Across The Globe Are Linked to Nine Risk Factors
Published in the Wall Street Journal, Monday August 30, 2004
MUNICH, Germany -- A large international study linked more than 90% of heart attacks to nine easy-to-measure risk factors common to essentially every region and ethnic group around the globe.
The findings add to the mounting evidence of the rising global burden of cardiovascular disease, particularly in developing countries, where it is supplanting infectious diseases as the most important cause of death. They also provide fresh insight into the risks for the disease and potential strategies for combating them.
"The risk factors are the same all over the planet," said Jean-Pierre Bassand, president of the European Society of Cardiology. "Political action is desperately needed" in all countries to devise plans geared toward prevention, he said.
More than 80% of deaths, heart attacks and other consequences of cardiovascular disease occur in developing nations, yet nearly all the data on risk factors come from the U.S. and Western Europe, where the problem has been intensely studied. Some small studies in the past had suggested that cholesterol abnormalities, for instance, might be less important for certain Asian populations, contributing to uncertainty about how broadly to apply some Western research to the rest of the world.
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The latest study, led by Salim Yusuf, director of the Population Health Research Institute at McMaster University, Hamilton, Ontario, included 15,152 patients from 52 countries who suffered a first heart attack and compared them with 14,820 people from their respective regions who were closely matched in age and gender but hadn't had a heart attack. All of the participants were evaluated for cholesterol abnormalities, smoking, diabetes, weight, depression and stress, and high blood pressure. They were also asked about their diets, exercise and alcohol consumption.
Using those nine measures, all of which doctors can evaluate through checkups with patients, "we can predict virtually all of the risk" of cardiovascular disease, Dr. Yusuf said. Those findings challenge much current thinking, which says that only about half of heart attacks are accounted for with conventional risk factors. That has prompted a search for markers of inflammation and other signals for heart risk.
But Dr. Yusuf said effort should be concentrated on the nine risk factors. "We should spend much more time and effort in understanding why people get these risks and how to change them," he argued.
The study was presented at the European Society of Cardiology's annual meeting here and is being published online in two papers later this week by the journal Lancet.
Translating the findings into effective strategies presents a huge challenge. Antismoking campaigns and more effective treatment of cholesterol in the U.S. have led to sharp declines in the past few decades in the rate of death from heart disease. Still, a rise in obesity and its associated contribution to diabetes and other problems now threaten to undercut that progress and are posing a global threat as well.
Dr. Yusuf proposed regulations controlling food advertising and urban planning to promote more physical activity to help combat the problem.
The study found abnormal cholesterol, as measured by a ratio of proteins called ApoB and ApoA-1, accounted for nearly 50% of the risk for heart attacks in the population. Current smoking and abdominal obesity were among other top predictors of cardiovascular disease. (Abdominal fat was determined to be a much more serious threat to heart health than fat that accumulates in the hips and buttocks.)
Depression and stress, which were determined from several different questionnaires used in the study, accounted for a 2.5-fold risk in a person's risk of a heart attack, a level that surprised Dr. Yusuf who previously had been skeptical of the role of psychosocial factors in heart disease.
Regular consumption of fruits and vegetables was associated with a 30% reduction of an individual's risk of a heart attack; regular exercise and moderate alcohol consumption lowered risk by 14% and 9%, respectively