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(Circulation. 2007;115:1075-1081.)
© 2007 American Heart Association, Inc.

Heart Disease in Latin America

Nonfatal Acute Myocardial Infarction in Costa Rica

Modifiable Risk Factors, Population-Attributable Risks, and Adherence to Dietary Guidelines

Edmond K. Kabagambe, BVM, PhD; Ana Baylin, MD, DrPH; Hannia Campos, PhD

From the Department of Epidemiology, University of Alabama at Birmingham, School of Public Health, Birmingham (E.K.K.); Brown University, Department of Community Health, Providence, RI (A.B.); and Department of Nutrition, Harvard School of Public Health, Boston, Mass, and Centro Centroamericano de Población, Universidad de Costa Rica, Costa Rica (H.C.).

Correspondence to Edmond K. Kabagambe, University of Alabama at Birmingham, School of Public Health, 1665 University Blvd, Ryals PH Bldg, Rm 230M, Birmingham, AL 35294-0022. E-mail edmondk{at}uab.edu

Received June 2, 2006; accepted December 5, 2006.

Background— Cardiovascular disease, including myocardial infarction (MI), is increasing in developing countries. Knowledge of risk factors and their impact on the population could offer insights into primary prevention.

Methods and Results— We estimated the population-attributable risk (PAR) for major MI risk factors among Costa Ricans without a history of diabetes, hypertension, or regular use of medication (889 MI cases, 1167 population-based controls). Lifestyle and dietary variables were measured with validated questionnaires. In multivariate analyses, abdominal obesity (PAR, 29.3%), smoking (PAR, 25.6%), nonuse of alcohol (PAR, 14.8%), caffeine intake (PAR, 12.8%), physical inactivity (PAR, 9.6%), and poor diet (PAR, 6.0%) were the most important MI risk factors. Subjects in the favorable categories of the above 6 risk factors showed a lower risk of MI (odds ratio, 0.09; 95% CI, 0.03 to 0.33) than those in the unfavorable categories. Compared with women, men were more likely to smoke (31% versus 10%) but less likely to have waist circumferences greater than Adult Treatment Panel III cutoffs (9% versus 35%). Many subjects did not meet the American Heart Association or World Health Organization/Food and Agriculture Organization dietary guidelines. For instance, 95% obtained 7% of energy from saturated fat, 25% had 5% of energy from polyunsaturated fat, 63% had 1% energy from trans fat, and 53% had low fiber intake (<25 g/d).

Conclusions— These findings confirm the benefit of a healthy diet, physical activity, moderate alcohol, and cessation of smoking as approaches for the primary prevention of MI. Obesity and smoking were the 2 most important risk factors for nonfatal MI in Costa Rica.

Key Words: coronary disease • Costa Rica • diet • lifestyle • myocardial infarction • risk factors

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