1. INTERHEART: Focus on 9 risk or protective factors
Design Large international case-control study
Participants 12,461 cases; 14,637 controls; 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
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2. INTERHEART: ApoB-ApoA1 ratio—Graded relation to MI risk, no evidence for a threshold8 4
Odds ratio for 1st MI (99% CI) 2 1
0.75 1 2 3 4 5 6 7 8 9 10
ApoB-ApoA1 ratio (deciles)
Number of controls
1210
1206
1208
1207
1209
Number of cases
435
496
610
720
790
893
1063
1196
1366
1757
Median
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
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3. INTERHEART: Significant association of MI risk with hypertension
Region n
Overall 26,916
Western Europe 1425
Central and Eastern Europe 3636
Middle East Crescent 3404
Africa 1355
South Asia 3881
China/Hong Kong 6075
Southeast Asia 2141
Australia and New Zealand 1269
South America 3100
North America 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
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4. Odds ratio for 1st MI (99% CI)
INTERHEART: Impact of multiple risk factors on CV risk
2.9
2.4
1.9
3.3
13.0
42.3
68.5
182.9
333.7
512
256
128
Odds ratio for 1st MI (99% CI) 64 32 16 8 4 2 1
Smk (1)
DM (2)
HTN (3)
ApoB- ApoA1 (4)
1+2+3
All 4
All 4 + Obes
All 4 + Ps
All risk factors
Smk = smoking
DM = diabetes
HTN = hypertension
Obes = obesity
Ps = psychosocial factors
Note: odds ratio plotted on a doubling scale
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5. INTERHEART: Association of risk factors with acute MI in women and men
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
0.5 1 2 4 8 16
Adjusted for age, sex, geographic region
Note: odds ratio plotted on a doubling scale
Odds ratio (99% CI)
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6. Adherence to simultaneous antihypertensive and lipid-regulating drug therapy
Retrospective analysis of data from PHARMetrics Integrated Outcomes Database 38 40 35 29 30
Patients adhering to therapy (%) 23 25 20 15 10 5
LRD first, AHD added
AHD first, LRD added
AHD + LRD initiated simultaneously
Adapted from Chapman RH et al. AHA Scientific Sessions Abstract 3417.
LRD = lipid-regulating drug; AHD = antihypertensive drug

7. 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
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