INTER-HEART: A global study of risk factors for acute myocardial infarction.

BACKGROUND Although declines in mortality rates have occurred in most developed countries, increases are being seen in developing countries. Our knowledge of risk factors for acute myocardial infarction (AMI) is largely derived from studies in the former. Applicability of these results to other populations is unknown. The objectives of INTER-HEART are to determine the association between risk factors and AMI within populations defined by ethnicity and/or geographic region and to assess the relative importance of risk factors across these populations. METHODS INTER-HEART is a study of 14,000 cases of AMI and 16,000 matched control patients from 46 countries, which was conducted with a standardized protocol. Questionnaires were translated into 11 languages; physical measurements were obtained, and 20 mL of blood was drawn and shipped frozen to a central laboratory in Canada. The study will evaluate the importance of conventional and emerging risk factors within each geographic region and whether their impact varies by region. RESULTS INTER-HEART is sponsored by the World Health Organization and the World Heart Federation and has received funding from several peer-reviewed agencies and many different pharmaceutical companies. A vanguard phase (February 1999 to 2000) enrolled 4000 subjects from 41 countries. Full data collection started in April 2000 and is expected to be completed by October 2002. CONCLUSIONS Several years of targeted work have allowed the development of the concepts that were tested in the pilot studies. This has ensured the feasibility of INTER-HEART. This study has the potential to have a major impact in developing a worldwide strategy for cardiovascular disease prevention, especially in developing countries and nonwhite populations.

[1]  S. Yusuf,et al.  Differences in risk factors, atherosclerosis, and cardiovascular disease between ethnic groups in Canada: the Study of Health Assessment and Risk in Ethnic groups (SHARE) , 2000, The Lancet.

[2]  E. Feskens,et al.  The Relation between Blood Pressure and Mortality Due to Coronary Heart Disease among Men in Different Parts of the World , 2000 .

[3]  S. Yusuf,et al.  Relationship of glucose and insulin levels to the risk of myocardial infarction: a case-control study. , 1999, Journal of the American College of Cardiology.

[4]  C. Hertzman,et al.  Socioeconomic factors, perceived control and self-reported health in Russia. A cross-sectional survey. , 1998, Social science & medicine.

[5]  H Schultz,et al.  Tobacco or health: A global status report. , 1998, Annals of Saudi medicine.

[6]  P. Poole‐Wilson,et al.  Cardiovascular specialty societies and the emerging global burden of cardiovascular disease: a call to action. , 1998, Circulation.

[7]  T. Lam,et al.  Mortality attributable to cigarette smoking in China. , 1997, JAMA.

[8]  R. Collins,et al.  Early health effects of the emerging tobacco epidemic in China. A 16-year prospective study. , 1997, JAMA.

[9]  M. Mckee,et al.  Huge variation in Russian mortality rates 1984–94: artefact, alcohol, or what? , 1997, The Lancet.

[10]  Sonia S Anand,et al.  Risk factors for cardiovascular disease in Canadians of South Asian and European origin: a pilot study of the Study of Heart Assessment and Risk in Ethnic Groups (SHARE). , 1997, Clinical and investigative medicine. Medecine clinique et experimentale.

[11]  A. Dobson,et al.  How much alcohol and how often? Population based case-control study of alcohol consumption and risk of a major coronary event , 1997, BMJ.

[12]  P. Sareli,et al.  Coronary heart disease: outlook for Africa , 1997, Journal of the Royal Society of Medicine.

[13]  L. Wilhelmsen,et al.  Physical activity protects against coronary death and deaths from all causes in middle-aged men. Evidence from a 20-year follow-up of the primary prevention study in Göteborg. , 1997, Annals of epidemiology.

[14]  Salim Yusuf,et al.  Risk factors for acute myocardial infarction in Indians: a case-control study , 1996, The Lancet.

[15]  Alan D. Lopez,et al.  The global burden of disease: a comprehensive assessment of mortality and disability from diseases injuries and risk factors in 1990 and projected to 2020. , 1996 .

[16]  C. La Vecchia,et al.  Attributable risks for nonfatal myocardial infarction in Italy. GISSI-EFRIM investigators. Gruppo Italiano per lo Studio della Sopravvivenza nell'Infarto Miocardico. Epidemiologia dei Fattori di Rischio dell'Infarto Miocardico. , 1995, Preventive medicine.

[17]  R. Collins,et al.  Cigarette smoking, tar yields, and non-fatal myocardial infarction : 14000 cases and 32000 controls in the United Kingdom , 1995 .

[18]  R. Collins,et al.  Cigarette smoking, tar yields, and non-fatal myocardial infarction: 14,000 cases and 32,000 controls in the United Kingdom. The International Studies of Infarct Survival (ISIS) Collaborators. , 1995, BMJ.

[19]  N. Chaturvedi,et al.  Methods for epidemiological surveys of ethnic minority groups. , 1994, Journal of epidemiology and community health.

[20]  B. C. Choi,et al.  Use of surnames to identify individuals of Chinese ancestry. , 1993, American journal of epidemiology.

[21]  A. Motala,et al.  The prevalence of diabetes mellitus and impaired glucose tolerance in a group of urban South African blacks. , 1993, South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde.

[22]  N. Breslow,et al.  Approximate inference in generalized linear mixed models , 1993 .

[23]  M. Rewers,et al.  Global Estimates for Prevalence of Diabetes Mellitus and Impaired Glucose Tolerance in Adults , 1993, Diabetes Care.

[24]  M. Marmot,et al.  Association of Early‐Onset Coronary Heart Disease in South Asian Men With Glucose Intolerance and Hyperinsulinemia , 1993, Circulation.

[25]  Reddy Ks,et al.  Cardiovascular diseases in India. , 1993, World health statistics quarterly. Rapport trimestriel de statistiques sanitaires mondiales.

[26]  A. Alwan.  Cardiovascular diseases in the eastern Mediterranean region. , 1993, World health statistics quarterly. Rapport trimestriel de statistiques sanitaires mondiales.

[27]  E. Riboli,et al.  Nutrition and cancer: background and rationale of the European Prospective Investigation into Cancer and Nutrition (EPIC). , 1992, Annals of oncology : official journal of the European Society for Medical Oncology.

[28]  J. Tuomilehto,et al.  Electrocardiographic abnormalities and associated factors in Chinese living in Beijing and in Mauritius. The Mauritius Non-Communicable Disease Study Group. , 1992, BMJ.

[29]  L. Wilhelmsen,et al.  Self-perceived psychological stress and incidence of coronary artery disease in middle-aged men. , 1991, The American journal of cardiology.

[30]  M. Fujishima,et al.  Smoking and cardiovascular disease in the general population in Japan. , 1990, Journal of hypertension. Supplement : official journal of the International Society of Hypertension.

[31]  P. McKeigue.  Coronary heart disease in south Asians overseas. , 1990 .

[32]  T. K. Young,et al.  Geographical distribution of diabetes among the native population of Canada: a national survey. , 1990, Social science & medicine.

[33]  M. Marmot,et al.  Coronary heart disease in south Asians overseas: a review. , 1989, Journal of clinical epidemiology.

[34]  J M Robins,et al.  The role of model selection in causal inference from nonexperimental data. , 1986, American journal of epidemiology.

[35]  H. Blackburn,et al.  Cardiovascular survey methods. , 1969, Monograph series. World Health Organization.

[36]  C. Martínez.  Santafé de Bogotá , 1968 .

[37]  T. Dawber,et al.  Epidemiological approaches to heart disease: the Framingham Study. , 1951, American journal of public health and the nation's health.