The INTERHEART study identified nine modifiable risk factors explaining >90% of attributable risk of acute myocardial infarction globally. Which factor had the HIGHEST population attributable risk (PAR%) in the study?

• A Dyslipidaemia (ApoB/ApoA-I ratio) ✓
• B Hypertension
• C Diabetes mellitus
• D Abnormal psychosocial factors (stress, depression)

Explanation

In the INTERHEART case-control study (Yusuf et al., Lancet 2004), dyslipidaemia represented by the ApoB/ApoA-I ratio had the highest PAR% (49.2%) for acute MI. Smoking was second (35.7%), and abnormal psychosocial factors third (32.5%). Hypertension (17.9%) and diabetes (9.9%) had lower individual PAR% despite being important risk factors. The ApoB/ApoA-I ratio was a stronger predictor of MI than LDL cholesterol in this global study, particularly in South Asians who have high small dense LDL with disproportionate cardiovascular risk.

Reference: Park's Textbook of Preventive and Social Medicine, 27th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

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