COMMENTARY

Further Analysis of INTERHEART: What Do the Data Tell Clinicians?

Arya Sharma, MD

January 19, 2006

The Clinical Message

The INTERHEART results have shown that CVD is basically the same disease process in all of the major ethnic populations of the world, and that the most important behavioral modification in terms of its impact on the burden of CVD is to get patients to stop smoking. This is closely followed, however, by the need to address the worldwide "epidemic" of obesity that is rapidly spreading as the world develops and adopts the habits of the more affluent "Western" lifestyle. Our recently published analysis of the INTERHEART data has shown that use of BMI as a measure of obesity results in an underestimation of the magnitude of obesity-attributable risk. In its place we should substitute measurement of abdominal girth, both to better estimate the population-attributable risk and to better assess our patients' risk. Reversing the increasing burden of CVD placed on our healthcare systems due to the growing problem of obesity will be difficult, because it will require changing behavior patterns that humans clearly enjoy -- but at least we can begin by more accurately assessing the dimensions of the problem.

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Cite this: Further Analysis of INTERHEART: What Do the Data Tell Clinicians? - Medscape - Jan 03, 2006.

Introduction
INTERHEART
Abdominal Obesity in INTERHEART
Metabolic Syndrome: Bringing It All Together?
Where Do We Go From Here?
The Clinical Message
References

INTERHEART: Risk of Acute MI Associated With Risk Factors in the Overall Population (Odds Ratio [OR])
Risk Factor	OR	99% Confidence Interval
ApoB/apoA1 (5 vs 1)*	3.25	2.82-3.76
Current smoking	2.87	2.58-3.19
Diabetes	2.37	2.07-2.71
Hypertension	1.91	1.74-2.10
Abdominal obesity (3 vs 1)^†	1.62	1.45-1.80
Psychosocial factors	2.67	2.21-3.22
Vegetables and fruit daily	0.70	0.62-0.79
Exercise	0.86	0.76-0.97
Alcohol intake	0.91	0.82-1.02

* Fifth quintile vs lowest quintile.
^† Top two quintiles vs lowest quintile

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