Transcript Document

INTERHEART: Focus on 9 risk
or protective factors
Design
VBWG
Large international case-control study
Participants 12,461 cases; 14,637 controls;
52 countries
Objective
To determine association of first MI with:
Smoking
Lipids
Hypertension
Diabetes
Obesity
Diet
Physical
Alcohol
Psychosocial
activity
consumption factors*
Follow-up
4 years, February 1999–March 2003
*eg, stress, depression
Yusuf S et al. Lancet. 2004;364:937-52.
VBWG
INTERHEART: ApoB-ApoA1 ratio—Graded
relation to MI risk, no evidence for a threshold
8
4
Odds ratio
for 1st MI
(99% CI)
2
1
0.75
1
Number of controls
Number of cases
Median
2
3
4
5
6
7
8
ApoB-ApoA1 ratio (deciles)
9
10
1210 1206 1208 1207 1210 1209 1207 1208 1208 1209
435 496 610 720 790 893 1063 1196 1366 1757
0.43 0.53 0.60 0.66 0.72 0.78 0.85 0.93 1.04 1.28
Note: odds ratio plotted on a doubling scale
Yusuf S et al. Lancet. 2004;364:937-52.
VBWG
INTERHEART: Significant association of MI
risk with hypertension
Region
Overall
Western Europe
Central and Eastern Europe
Middle East Crescent
Africa
South Asia
China/Hong Kong
Southeast Asia
Australia and New Zealand
South America
North America
n
26,916
1425
3636
3404
1355
3881
6075
2141
1269
3100
630
0.25
0.5
1
2
4
8
16
Odds ratio (95% CI)
Adjusted for age, sex, smoking
Note: odds ratio plotted on a doubling scale
Yusuf S et al. Lancet. 2004;364:937-52.
VBWG
INTERHEART: Impact of multiple risk factors
on CV risk
2.9
2.4
1.9
Smk
DM
HTN
3.3
13.0
42.3
68.5
182.9
333.7
All 4
All 4
+ Obes + Ps
All risk
factors
512
256
128
Odds
ratio 64
for 32
1st MI
16
(99%
8
CI)
4
2
1
Smk = smoking
(1)
(2)
(3)
DM = diabetes
HTN = hypertension
Obes = obesity
Ps = psychosocial factors
Note: odds ratio plotted on a doubling scale
ApoB- 1+2+3
ApoA1
(4)
All 4
Yusuf S et al. Lancet. 2004;364:937-52.
VBWG
INTERHEART: Association of risk factors
with acute MI in women and men
Risk factor
Gender
Current smoking
F
M
Diabetes
F
M
Hypertension
F
M
Abdominal obesity
F
M
Psychosocial index
F
M
Fruits/Vegetables
F
M
Exercise
F
M
Alcohol
F
M
ApoB-ApoA1 ratio
F
M
0.25
Adjusted for age, sex, geographic region
Note: odds ratio plotted on a doubling scale
0.5
1
2
4
Odds ratio (99% CI)
8
16
Yusuf S et al. Lancet. 2004;364:937-52.
Adherence to simultaneous antihypertensive
and lipid-regulating drug therapy
VBWG
Retrospective analysis of data from PHARMetrics Integrated Outcomes Database
38
40
35
29
30
Patients
adhering
to therapy
(%)
25
23
20
15
10
5
0
LRD first,
AHD added
LRD = lipid-regulating drug; AHD = antihypertensive drug
AHD first, AHD + LRD initiated
LRD added
simultaneously
Adapted from Chapman RH et al.
AHA Scientific Sessions 2003. Abstract 3417.
VBWG
INTERHEART: Clinical implications
• 9 simple and modifiable risk factors are strongly
associated with acute MI worldwide.
• These 9 risk factors account for >90% of the PAR
globally and in most regions.
• Abnormal ApoB-ApoA1 ratio and smoking are the 2
most important risk factors and account for over
two thirds of the PAR.
• Implementing preventive strategies based on our
current knowledge would prevent the majority of
premature CHD worldwide.
PAR = population attributable risk
Apo = apolipoprotein
Yusuf S et al. Lancet. 2004;364:937-52.