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(Circulation. 2005;112:3554-3561.)
© 2005 American Heart Association, Inc.

Heart Disease in Africa

Risk Factors Associated With Myocardial Infarction in Africa

The INTERHEART Africa Study

Krisela Steyn, MD; Karen Sliwa, MD; Steven Hawken, MSc; Patrick Commerford, FCP(SA); Churchill Onen, FRCP(Lond); Albertino Damasceno, MD, PhD; Stephanie Ounpuu, PhD; Salim Yusuf, DPhil, FRCP, for the INTERHEART Investigators in Africa

From the Chronic Diseases of Lifestyle Unit, Medical Research Council, Tygerberg, South Africa (K. Steyn); Department of Cardiology, Chris-Hani-Baragwanath Hospital, University of the Witwatersrand, Johannesburg, South Africa (K. Sliwa); Population Health Research Institute, Hamilton General Hospital, Hamilton, Ontario, Canada (S.H., S.O., S.Y.); Cardiac Clinic, Department of Medicine, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa (P.C.); Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique (A.D.); and Center for Chronic Diseases, Gaborone Private Hospital, Gaborone, Botswana (C.O.).

Correspondence to Prof Salim Yusuf, Population Health Research Institute, Hamilton General Hospital, 237 Barton St E, Hamilton, Ontario, Canada L8L 2X2. E-mail yusufs{at}mcmaster.ca

Received May 20, 2005; revision received July 11, 2005; accepted August 8, 2005.

Background— Cardiovascular disease (CVD) is rising in low-income countries. However, the impact of modifiable CVD risk factors on myocardial infarction (MI) has not been studied in sub-Saharan Africa (SSA). Therefore, we conducted a case-control study among patients with acute MI (AMI) in SSA to explore its association with known CVD risk factors.

Methods and Results— First-time AMI patients (n=578) were matched to 785 controls by age and sex in 9 SSA countries, with South Africa contributing 80% of the participants. The relationships between risk factors and AMI were investigated in the African population and in 3 ethnic subgroups (black, colored, and European/other Africans) and compared with those found in the overall INTERHEART study. Relationships between common CVD risk factors and AMI were found to be similar to those in the overall INTERHEART study. Modeling of 5 risk factors (smoking history, diabetes history, hypertension history, abdominal obesity, and ratio of apolipoprotein B to apolipoprotein A-1) provided a population attributable risk of 89.2% for AMI. The risk for AMI increased with higher income and education in the black African group in contrast to findings in the other African groups. A history of hypertension revealed higher MI risk in the black African group than in the overall INTERHEART group.

Conclusions— Known CVD risk factors account for 90% of MI observed in African populations, which is consistent with the overall INTERHEART study. Contrasting gradients found in socioeconomic class, risk factor patterns, and AMI risk in the ethnic groups suggest that they are at different stages of the epidemiological transition.

Key Words: apolipoproteins • cardiovascular diseases • myocardial infarction • population • risk factors

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