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A major global
study has found that the vast majority of heart attacks may be predicted
by nine easily measurable factors which apply to virtually every
region and ethnic group worldwide.
The INTERHEART study, one
of the largest case control studies examining the importance of heart disease
risk factors, looked at more than 29,000 people in 52 countries from all inhabited
continents of the world. The study was coordinated by Dr Salim Yusuf, Professor
of Medicine at the Michael G. DeGroote School of Medicine at McMaster
University and Director of the Population
Health Research Institute at McMaster
University and Hamilton Health Sciences,
Ontario, Canada.
Aga Khan University (AKU), Karachi was the coordinating
centre for Pakistan with
five centres in Karachi, Hyderabad
and Islamabad
contributing nearly 1,400 subjects to the study. Dr Khawar Kazmi, Head, Section
of Cardiology at Aga Khan University Hospital (AKUH), was the national coordinator.
The study found that the
two most significant risk factors are cigarette smoking and an abnormal ratio
of blood lipids (apolipoprotein B and A-I), which together account for two-thirds
of the global risk of heart attack. Additional risk factors include high blood
pressure, diabetes, abdominal obesity, stress, inadequate consumption of fruits
and vegetables, and lack of daily exercise. Worldwide, these nine factors can
collectively predict over 90 per cent of potential heart attack.
The INTERHEART study involved
15,152 individuals who had suffered one heart attack and 14,820 others who did
not have heart disease but who were of the same age, gender and from the same
city. This major study is the first examination of whether risk factors for
heart attack have a similar or different impact on all major ethnic groups and
major areas of the world. It included 4,000 South Asians, 7,000 people of European
extraction, 2,000 from Latin America, 1,400 Africans, 6,000 Chinese, 3,500 Arabs
and 2,000 subjects from other parts of Asia.
The INTERHEART study results
were presented at the European Society of Cardiology (ESC) conference in Munich,
Germany, in August
2004 and results were published in the prestigious medical journal The
Lancet on September
11, 2004.
According to Dr Khawar Kazmi
of AKUH, conventional wisdom had previously suggested that only half of the
risk of heart attacks may be foreseen. However, the INTERHEART findings mean
the overwhelming majority of heart attack risk may be predicted.
"These factors appear to
predict the majority of the risk in virtually every region, every ethnic group,
in men and women and in the old and the young," said Dr Kazmi. "This suggests
that the message of preventing cardiovascular disease can be quite simple and
generally similar across the world, after taking into account economic and cultural
differences. "Since these risk factors may all be modified, this study will
change the way we look at heart attack prevention. It means we should be able
to prevent the majority of premature heart attacks in the world. This is a landmark
study."
Dr Kazmi explained that
the study suggests that a combination of lifestyle changes including smoking
cessation, healthier diet and increased exercise could lead to an 80 per cent
reduction in the risk of heart attacks," he said. "The INTERHEART study provides
the research evidence needed to build national and international programmes
for the prevention and control of one the leading cause of death in Pakistan and across the world."
Dr Kazmi added that the
study is of great relevance to Pakistan. "This is the largest data study to date in Pakistan on the risk factors for acute
heart attack and guides us in developing strategies for the prevention of the
rising epidemic of coronary artery disease," he elaborated, urging the medical
community, government and NGOs to join hands and work together for this cause.
He also highlighted the initiative taken by AKU in the form of a Smart Heart
Programme which has three major components:
- Increasing awareness
of heart disease and healthy lifestyles among the general public;
- Continued educational
activities for general practitioners which will help standardise patient care
at the grass root level.
- Creating awareness of
healthy lifestyles in school children.
In this connection, AKU's
Smart Heart Programme is also celebrating World Heart Day on September, 26, 2004. The theme this year is 'Children,
Adolescents and Heart Disease' and an education-cum-entertainment programme
has been arranged on the day for school children at AKUH.
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