Circulation. 2007;115:1059
(Circulation. 2007;115:1059.)
© 2007 American Heart Association, Inc.
Issue Highlights
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RISK FACTORS FOR ACUTE MYOCARDIAL INFARCTION IN LATIN AMERICA: THE INTERHEART LATIN AMERICAN STUDY, by Lanas et al.
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Ischemic heart disease is the leading cause of death in Latin
America, causing 26% of all deaths in the region in 1990, and
it will remain the main cause of death in the region for decades
to come. In order to assess the importance of traditional risk
factors for acute myocardial infarction (AMI), 6 Latin American
countries participated in INTERHEART, which is the largest study
on risk factors for AMI conducted in this region. As part of
the INTERHEART study, 1237 cases of first acute myocardial infarction
and 1888 controls were enrolled in Argentina, Brazil, Colombia,
Chile, Guatemala, and Mexico. Data on smoking behavior, history
of hypertension and diabetes, dietary patterns, physical activity,
alcohol consumption and psychosocial factors, anthropometry,
and blood pressure were collected. Persistent psychosocial stress,
history of hypertension and diabetes, current smoking, increased
waist-to-hip ratio and increased ratio of apolipoprotein B to
apolipoprotein A-1 increased the risk of AMI. Daily consumption
of fruits or vegetables and regular exercise reduced the risk
of AMI. Abdominal obesity, abnormal lipids, and smoking were
the largest contributors to the risk of AMI, with population
attributable risk of 48.5%, 40.8% and 38.4%, respectively; collectively
these 10 risk factors accounted for 88% of the population’s
attributable risk. The present study by Lanas et al suggests
that regular exercise, a prudent diet, and avoidance of smoking
could have a large impact, and that the majority of AMI in Latin
America could be avoided by lifestyle modifications. See p
1067.
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NONFATAL ACUTE MYOCARDIAL INFARCTION IN COSTA RICA: MODIFIABLE RISK FACTORS, POPULATION-ATTRIBUTABLE RISKS, AND ADHERENCE TO DIETARY GUIDELINES, by Kabagambe et al.
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Cardiovascular disease, including myocardial infarction (MI),
is increasing in developing countries. Knowledge of risk factors
and their impact on the population could offer insight into
primary prevention. The present study by Kabagambe and colleagues
identified major MI risk factors and estimated their contribution
to MI among Costa Ricans without a history of diabetes, hypertension,
or regular use of medication (889 MI cases and 1167 population-based
controls). Lifestyle and dietary variables were measured with
validated questionnaires. In analyses adjusted for several confounders,
the investigators found that abdominal obesity, smoking, nonuse
of alcohol, caffeine intake, physical inactivity, and consumption
of a poor diet were the most important MI risk factors in Costa
Rica. Subjects in the favorable categories of the 6 risk factors
noted above were 91% less likely to have an MI than those in
the unfavorable categories. Compared with women, men were more
likely to smoke (54% men vs 12% women) but less likely to have
waist circumferences greater than Adult Treatment Panel III
cutoffs (9% men vs 35% women). Many subjects did not meet the
American Heart Association or World Health Organization/Food
and Agriculture Organization dietary guidelines. For instance,
96% 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 (
25g/d). These findings
confirm the benefit of a healthy diet, physical activity, moderate
alcohol use, and cessation of smoking as approaches for primary
prevention of MI. See p
1075.
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FIVE-YEAR FOLLOW-UP OF THE MEDICINE, ANGIOPLASTY, OR SURGERY STUDY (MASS II): A RANDOMIZED CONTROLLED CLINICAL TRIAL OF 3 THERAPEUTIC STRATEGIES FOR MULTIVESSEL CORONARY ARTERY DISEASE, by Hueb et al.
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Percutaneous coronary intervention (PCI) is used widely in the
management of patients with coronary artery disease and is an
alternative to coronary artery bypass grafting (CABG) for selected
patients with angina. Bypass surgery is an effective treatment
for angina, and randomized trials suggest that long-term survival
is better than with medical treatment (MT) in some subgroups
of patients. However, current therapeutic strategies, including
aggressive modification of risk factors and intermittent use
of drugs, have improved the outcomes of patients with coronary
artery disease. The MASS II was therefore designed to compare
the relative efficacy of CABG, PCI, or MT in the management
of patients with symptomatic multivessel coronary artery disease.
The primary end point was defined as overall mortality, Q-wave
myocardial infarction, or refractory angina requiring revascularization.
All data were analyzed according to the intention-to-treat principle.
A total of 611 patients were randomly assigned to either a CABG
(n=203), PCI (n=205), or MT (n=203). At 5 years, there were
16 deaths in the CABG group, 24 deaths in the PCI group, and
25 deaths in the MT group (
P=0.631). The primary end point was
reported in 21.2% of patients referred to surgery as compared
with 32.7% treated with PCI, and 36% who only received MT (
P=0.0026).
All 3 therapeutic strategies yielded comparable and relatively
low rates of mortality. MT was associated with similar incidence
of long-term events and rate of additional revascularization
compared with PCI. CABG was superior to MT with regards to the
primary end point, reaching a 44% reduction at 5-year follow-up.
See p
1082.
Visit http://circ.ahajournals.org:
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Clinician Update
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Prevention of Pulmonary Embolism in General Surgery Patients.
See p e302.
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Images in Cardiovascular Medicine
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High-Altitude–Induced Right-Heart Failure. See p
e308.
Hypertensive Brainstem Encephalopathy. See p e310.
Virtual Cardiotomy for Preoperative Planning. See p e312.
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Correspondence
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See p
e313.
Related Articles:
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Risk Factors for Acute Myocardial Infarction in Latin America: The INTERHEART Latin American Study
- Fernando Lanas, Alvaro Avezum, Leonelo E. Bautista, Rafael Diaz, Max Luna, Shofiqul Islam, Salim Yusuf for the INTERHEART Investigators in Latin America
Circulation 2007 115: 1067-1074.
[Abstract]
[Full Text]
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Circulation 2007 115: 1075-1081.
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Circulation 2007 115: e302-e307.
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Circulation 2007 115: e308-e309.
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Circulation 2007 115: e310-e311.
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[Full Text]
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[Full Text]
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