Yusuf Salim, Hawken Steven, Ounpuu Stephanie, Dans Tony, Avezum Alvaro, Lanas Fernando, McQueen Matthew, Budaj Andrzej, Pais Prem, Varigos John, Lisheng Liu
Population Health Research Institute, Hamilton General Hospital, 237 Barton Street East, Hamilton, Ontario, Canada L8L 2X2.
Lancet. 2004;364(9438):937-52. doi: 10.1016/S0140-6736(04)17018-9.
Although more than 80% of the global burden of cardiovascular disease occurs in low-income and middle-income countries, knowledge of the importance of risk factors is largely derived from developed countries. Therefore, the effect of such factors on risk of coronary heart disease in most regions of the world is unknown.
We established a standardised case-control study of acute myocardial infarction in 52 countries, representing every inhabited continent. 15152 cases and 14820 controls were enrolled. The relation of smoking, history of hypertension or diabetes, waist/hip ratio, dietary patterns, physical activity, consumption of alcohol, blood apolipoproteins (Apo), and psychosocial factors to myocardial infarction are reported here. Odds ratios and their 99% CIs for the association of risk factors to myocardial infarction and their population attributable risks (PAR) were calculated.
Smoking (odds ratio 2.87 for current vs never, PAR 35.7% for current and former vs never), raised ApoB/ApoA1 ratio (3.25 for top vs lowest quintile, PAR 49.2% for top four quintiles vs lowest quintile), history of hypertension (1.91, PAR 17.9%), diabetes (2.37, PAR 9.9%), abdominal obesity (1.12 for top vs lowest tertile and 1.62 for middle vs lowest tertile, PAR 20.1% for top two tertiles vs lowest tertile), psychosocial factors (2.67, PAR 32.5%), daily consumption of fruits and vegetables (0.70, PAR 13.7% for lack of daily consumption), regular alcohol consumption (0.91, PAR 6.7%), and regular physical activity (0.86, PAR 12.2%), were all significantly related to acute myocardial infarction (p<0.0001 for all risk factors and p=0.03 for alcohol). These associations were noted in men and women, old and young, and in all regions of the world. Collectively, these nine risk factors accounted for 90% of the PAR in men and 94% in women.
Abnormal lipids, smoking, hypertension, diabetes, abdominal obesity, psychosocial factors, consumption of fruits, vegetables, and alcohol, and regular physical activity account for most of the risk of myocardial infarction worldwide in both sexes and at all ages in all regions. This finding suggests that approaches to prevention can be based on similar principles worldwide and have the potential to prevent most premature cases of myocardial infarction.
尽管全球超过80%的心血管疾病负担发生在低收入和中等收入国家，但对风险因素重要性的认识主要来自发达国家。因此，这些因素对世界上大多数地区冠心病风险的影响尚不清楚。
我们在代表每个有人居住大陆的52个国家建立了一项关于急性心肌梗死的标准化病例对照研究。共纳入15152例病例和14820例对照。本文报告了吸烟、高血压或糖尿病病史、腰臀比、饮食模式、身体活动、饮酒量、血液载脂蛋白（Apo）以及心理社会因素与心肌梗死的关系。计算了风险因素与心肌梗死关联的比值比及其99%可信区间以及它们的人群归因风险（PAR）。
吸烟（当前吸烟者与从不吸烟者的比值比为2.87，当前和既往吸烟者与从不吸烟者相比的PAR为35.7%）、升高的ApoB/ApoA1比值（最高五分位数与最低五分位数相比为3.25，前四个五分位数与最低五分位数相比的PAR为49.2%）、高血压病史（1.91，PAR为17.9%）、糖尿病（2.37，PAR为9.9%）、腹型肥胖（最高三分位数与最低三分位数相比为1.12，中间三分位数与最低三分位数相比为1.62，前两个三分位数与最低三分位数相比的PAR为20.1%）、心理社会因素（2.67，PAR为32.5%）、每日食用水果和蔬菜（0.70，缺乏每日食用的PAR为13.7%）、经常饮酒（0.91，PAR为6.7%）以及经常进行体育活动（0.86，PAR为12.2%），均与急性心肌梗死显著相关（所有风险因素p<0.0001，饮酒p=0.03）。这些关联在男性和女性、老年人和年轻人以及世界所有地区均有发现。总体而言，这九个风险因素占男性PAR的90%，占女性PAR的94%。
血脂异常、吸烟、高血压、糖尿病、腹型肥胖、心理社会因素、水果、蔬菜和酒精的摄入以及经常进行体育活动，在全球范围内的所有年龄段和所有地区的男女中，占心肌梗死风险的大部分。这一发现表明，预防方法在全球范围内可以基于相似的原则，并且有可能预防大多数心肌梗死的过早发病病例。
