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(Circulation. 2007;115:1067-1074.)
© 2007 American Heart Association, Inc.

Heart Disease in Latin America

Risk Factors for Acute Myocardial Infarction in Latin America

The INTERHEART Latin American Study

Fernando Lanas, MSc, MD; Alvaro Avezum, MD, PhD; Leonelo E. Bautista, MD, DrPH; Rafael Diaz, MD; Max Luna, MD; Shofiqul Islam, MSc; Salim Yusuf, DPhil, FRCP, for the INTERHEART Investigators in Latin America

From the Facultad de Medicina, Universidad de la Frontera, Temuco, Chile (F.L.); Instituto Dante Pazzanese de Cardiologia, Sao Paulo, Brazil (A.A.); Fundación Cardiovascular del Oriente Colombiano and Department of Population Health Sciences, University of Wisconsin, Madison (L.E.B.); ECLA Coordinating Center and Instituto Cardiovascular de Rosario, Rosario, Argentina (R.D.); Unidad de Cirugia Cardiovascular de Guatemala, Guatemala, and Ochsner Clinic Foundation, Covington, La (M.L.); and Population Health Research Institute, Health Sciences and McMaster University, Hamilton, Ontario, Canada (S.I., S.Y.).

Correspondence to Fernando Lanas, Facultad de Medicina, Universidad de La Frontera M, Montt 112 Temuco, Chile. E-mail flanas{at}ufro.cl

Received April 11, 2006; accepted September 5, 2006.

Background— Current knowledge of the impact of cardiovascular risk factors in Latin America is limited.

Methods and Results— As part of the INTERHEART study, 1237 cases of first acute myocardial infarction and 1888 age-, sex-, and center-matched controls were enrolled from Argentina, Brazil, Colombia, Chile, Guatemala, and Mexico. History of smoking, hypertension, diabetes mellitus, diet, physical activity, alcohol consumption, psychosocial factors, anthropometry, and blood pressure were recorded. Nonfasting blood samples were analyzed for apolipoproteins A-1 and B-100. Logistic regression was used to estimate multivariate adjusted odds ratios (ORs) and their 95% confidence intervals (CIs). Persistent psychosocial stress (OR, 2.81; 95% CI, 2.07 to 3.82), history of hypertension (OR, 2.81; 95% CI, 2.39 to 3.31), diabetes mellitus (OR, 2.59; 95% CI, 2.09 to 3.22), current smoking (OR, 2.31; 95% CI, 1.97 to 2.71), increased waist-to-hip ratio (OR for first versus third tertile, 2.49; 95% CI, 1.97 to 3.14), and increased ratio of apolipoprotein B to A-1 (OR for first versus third tertile, 2.31; 95% CI, 1.83 to 2.94) were associated with higher risk of acute myocardial infarction. Daily consumption of fruits or vegetables (OR, 0.63; 95% CI, 0.51 to 0.78) and regular exercise (OR, 0.67; 95% CI, 0.55 to 0.82) reduced the risk of acute myocardial infarction. Abdominal obesity, abnormal lipids, and smoking were associated with high population-attributable risks of 48.5%, 40.8%, and 38.4%, respectively. Collectively, these risk factors accounted for 88% of the population-attributable risk.

Conclusions— Interventions aimed at decreasing behavioral risk factors, lowering blood pressure, and modifying lipids could have a large impact on the risk of acute myocardial infarction among Latin Americans.

Key Words: cardiovascular diseases • epidemiology • Latin America • lipoproteins • myocardial infarction • obesity • risk factors

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Risk Factors for Acute Myocardial Infarction in Latin America: The INTERHEART Latin American Study

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