Failing to consume fruit and vegetables every day was associated with a PAR of 14%, regular moderate alcohol consumption was linked to a protective effect of 7% in the PAR, and regular physical activity had a protective effect on PAR of 12%.
“One of the most important risk factors for acute myocardial infarction in our study was smoking, which accounts for about 36% of the PAR of acute myocardial infraction worldwide (and about 44% in men). Regular consumption of fruits and vegetables was associated with a 30% relative risk reduction,” Dr. Yusuf and his associates said.
“Thus, eating fruit and vegetables, taking exercise, and avoiding smoking could lead to about 80% lower relative risk for myocardial infarction,” the researchers added.
The researchers noticed a “clear, significant, and consistent excess risk” of acute MI in most regions of the world and in every ethnic group for most of these risk factors, with the exceptions of alcohol consumption, exercise, and diet.
Among all regions, the nine risk factors accounted for between three-quarters and nearly all of the PAR for acute MI. “However, raised lipids, smoking, and psychosocial factors were the most important risk factors in all regions of the world,” Dr. Yusuf reported.
Although geographic priorities can differ by region because of differences in prevalence of risk factors such as diet, disease, and economic circumstances, the approaches to prevention can be based on similar principles throughout the world, the researchers said.
This study will probably inspire much more research in these areas and “contribute to an aura of legitimacy for behavioral research studies” and “make it easier for future behavioral research to reach a wider medical audience,” David S. Sheps, M.D., of the University of Florida, Gainesville, and his associates said in an accompanying editorial (Psychosomatic Medicine 2004;66:797-8).