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Risk Factors for Early Myocardial Infarction in South Asians Compared With Individuals in Other Countries
Prashant Joshi, MD;
Shofiqul Islam, MSc;
Prem Pais, MD;
Srinath Reddy, MD;
Prabhakaran Dorairaj, MD;
Khawar Kazmi, MBBS;
Mrigendra Raj Pandey, MBBS;
Sirajul Haque, MBBS;
Shanthi Mendis, MD;
Sumathy Rangarajan, MSc;
Salim Yusuf, MD, DPhil
JAMA. 2007;297:286-294.
Context South Asians have high rates of acute myocardial infarction (AMI) at younger ages compared with individuals from other countries but the reasons for this are unclear.
Objective To evaluate the association of risk factors for AMI in native South Asians, especially at younger ages, compared with individuals from other countries.
Design, Setting, and Participants Standardized case-control study of 1732 cases with first AMI and 2204 controls matched by age and sex from 15 medical centers in 5 South Asian countries and 10 728 cases and 12 431 controls from other countries. Individuals were recruited to the study between February 1999 and March 2003.
Main Outcome Measure Association of risk factors for AMI.
Results The mean (SD) age for first AMI was lower in South Asian countries (53.0 [11.4] years) than in other countries (58.8 [12.2] years; P<.001). Protective factors were lower in South Asian controls than in controls from other countries (moderate- or high-intensity exercise, 6.1% vs 21.6%; daily intake of fruits and vegetables, 26.5% vs 45.2%; alcohol consumption  once/wk, 10.7% vs 26.9%). However, some harmful factors were more common in native South Asians than in individuals from other countries (elevated apolipoprotein B100 /apolipoprotein A-I ratio, 43.8% vs 31.8%; history of diabetes, 9.5% vs 7.2%). Similar relative associations were found in South Asians compared with individuals from other countries for the risk factors of current and former smoking, apolipoprotein B100 /apolipoprotein A-I ratio for the top vs lowest tertile, waist-to-hip ratio for the top vs lowest tertile, history of hypertension, history of diabetes, psychosocial factors such as depression and stress at work or home, regular moderate- or high-intensity exercise, and daily intake of fruits and vegetables. Alcohol consumption was not found to be a risk factor for AMI in South Asians. The combined odds ratio for all 9 risk factors was similar in South Asians (123.3; 95% confidence interval [CI], 38.7-400.2] and in individuals from other countries (125.7; 95% CI, 88.5-178.4). The similarities in the odds ratios for the risk factors explained a high and similar degree of population attributable risk in both groups (85.8% [95% CI, 78.0%-93.7%] vs 88.2% [95% CI, 86.3%-89.9%], respectively). When stratified by age, South Asians had more risk factors at ages younger than 60 years. After adjusting for all 9 risk factors, the predictive probability of classifying an AMI case as being younger than 40 years was similar in individuals from South Asian countries and those from other countries.
Conclusion The earlier age of AMI in South Asians can be largely explained by higher risk factor levels at younger ages.
Author Affiliations: Department of Medicine, Government Medical College, Nagpur, India (Dr Joshi); Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Ontario (Mr Islam, Ms Rangarajan, and Dr Yusuf); Department of Medicine, St John's Medical College, Bangalore, India (Dr Pais); All India Institute of Medical Sciences, New Delhi, India (Drs Reddy and Dorairaj); Department of Cardiology, Aga Khan Univer sity, Karachi, Pakistan (Dr Kazmi); Nepal Hypertension Society, Nepal (Dr Pandey); Department of Cardiology, Bangabandhu Sheikh Medical University, Bangladesh (Dr Haque); and World Health Organization, Geneva, Switzerland (Dr Mendis).
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