Risk factors for early myocardial infarction in South Asians compared with individuals in other countries
Risk factors for early myocardial infarction in South Asians compared with individuals in other countries
复制标题
DOI：
10.1001/jama.297.3.286
复制
发表时间：
2007-01-17
影响因子：
120.7
通讯作者：
Yusuf, Salim
中科院分区：
文献类型：
--
作者：
Joshi, Prashant;Islam, Shofiqul;Yusuf, Salim
背景与其他国家的个体相比，南亚人在年轻时急性心肌梗死（AMI）的发病率较高，但其原因尚不清楚。和参与者对来自5个南亚国家15个医疗中心的1732例首次AMI病例和2204名年龄和性别匹配的对照以及来自其他国家的10728例病例和12431名对照进行了标准化病例对照研究。个体被招募到1999年2月至2003年3月之间的研究。主要结果测量AMI危险因素的关联。结果南亚国家首次AMI的平均（SD）年龄（53.0 [11.4]岁）低于其他国家（58.8 [12.2]岁; P =一次/周，10.7%比26.9%）。然而，一些有害因素在本地南亚人中比来自其他国家的个体更常见（载脂蛋白B-100/载脂蛋白A-I比值升高，43.8%对31.8%;糖尿病史，9.5%对7.2%）。与来自其他国家的个体相比，南亚人在当前和既往吸烟的风险因素、载脂蛋白B100/载脂蛋白A-I比值（最高与最低三分位数）、腰臀比（最高与最低三分位数）、高血压史、糖尿病史、心理社会因素（如抑郁和工作或家庭压力）、定期进行中强度或高强度运动，每天摄入水果和蔬菜。在南亚人中，饮酒并不是AMI的危险因素。所有9个风险因素的合并比值比在南亚人（123.3; 95%置信区间[CI]，38.7-400.2]和其他国家的个体（125.7; 95% CI，88.5-178.4）中相似。危险因素比值比的相似性解释了两组人群归因风险的高和相似程度（分别为85.8%[95%CI，78.0%-93.7%] vs 88.2% [95%CI，86.3%-89.9%]）。当按年龄分层时，南亚人在年龄小于60岁时有更多的风险因素。调整后的所有9个危险因素，分类为小于40岁的AMI病例的预测概率是相似的，在个人从南亚国家和那些从其他countries.Conclusion在南亚人的AMI的早期年龄可以在很大程度上解释了较高的危险因素水平，在年轻的年龄。
Context South Asians have high rates of acute myocardial infarction ( AMI) at younger ages compared with individuals from other countries but the reasons for this are unclear.Objective To evaluate the association of risk factors for AMI in native South Asians, especially at younger ages, compared with individuals from other countries.Design, Setting, and Participants Standardized case-control study of 1732 cases with first AMI and 2204 controls matched by age and sex from 15 medical centers in 5 South Asian countries and 10 728 cases and 12 431 controls from other countries. Individuals were recruited to the study between February 1999 and March 2003.Main Outcome Measure Association of risk factors for AMI.Results The mean(SD) age for first AMI was lower in South Asian countries ( 53.0 [11.4] years) than in other countries ( 58.8 [12.2] years; P = once/wk, 10.7% vs 26.9%). However, some harmful factors were more common in native South Asians than in individuals from other countries ( elevated apolipoprotein B-100/ apolipoprotein A-I ratio, 43.8% vs31.8%; history of diabetes, 9.5% vs 7.2%). Similar relative associations were found in South Asians compared with individuals from other countries for the risk factors of current and former smoking, apolipoprotein B100/ apolipoprotein A-I ratio for the top vs lowest tertile, waist-to-hip ratio for the top vs lowest tertile, history of hypertension, history of diabetes, psychosocial factors such as depression and stress at work or home, regular moderate- or high-intensity exercise, and daily intake of fruits and vegetables. Alcohol consumption was not found to be a risk factor for AMI in South Asians. The combined odds ratio for all 9 risk factors was similar in South Asians (123.3; 95% confidence interval [CI], 38.7-400.2] and in individuals from other countries (125.7; 95% CI, 88.5-178.4). The similarities in the odds ratios for the risk factors explained a high and similar degree of population attributable risk in both groups (85.8%[ 95% CI, 78.0%-93.7%] vs 88.2% [ 95% CI, 86.3%-89.9%], respectively). When stratified by age, South Asians had more risk factors at ages younger than 60 years. After adjusting for all 9 risk factors, the predictive probability of classifying an AMI case as being younger than 40 years was similar in individuals from South Asian countries and those from other countries.Conclusion The earlier age of AMI in South Asians can be largely explained by higher risk factor levels at younger ages.