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Publications

Journal Article Epublish

PubMed: 39811539 DOI: 10.1016/j.lansea.2024.100519

Conventional and regionally distinctive risk factors for first-onset myocardial infarction: the Bangladesh Risk of Acute Vascular Events (BRAVE) case-control study.

Lancet Reg Health Southeast Asia 32:100519

Authors: Rajiv Chowdhury, Aliya Naheed, Md Mostafa Monower, Sara Shahzad, Rubhana Raqib, Ishrat Tasmin, Sarah Spackman, Stephen Kaptoge, Lisa Pennells, Adam S Butterworth, John Danesh, Emanuele Di Angelantonio

Affiliations

  • Department of Global Health, Stempel College of Public Health and Social Work, Florida International University, Miami, FL, USA.
  • Initiative for Non Communicable Disease, Health Systems Studies Division, icddr,b, Mohakhali, Dhaka, Bangladesh.
  • Non Communicable Diseases, Nutrition Research Division, icddr,b, Mohakhali, Dhaka, Bangladesh.
  • Department of Epidemiology and Research, National Heart Foundation Hospital and Research Institute, Dhaka, Bangladesh.
  • British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK.
  • Infectious Diseases Division, icddr,b, Mohakhali, Dhaka, Bangladesh.
  • British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK. Victor Phillip Dahdaleh Heart and Lung Research Institute, University of Cambridge, Cambridge, UK.
  • Victor Phillip Dahdaleh Heart and Lung Research Institute, University of Cambridge, Cambridge, UK.
  • British Heart Foundation Centre of Research Excellence, University of Cambridge, Cambridge, UK.
  • National Institute for Health and Care Research Blood and Transplant Research Unit in Donor Health and Behaviour, University of Cambridge, Cambridge, UK.
  • Health Data Research UK Cambridge, Wellcome Genome Campus and University of Cambridge, Cambridge, UK.
  • Department of Human Genetics, Wellcome Sanger Institute, Hinxton, UK.
  • Health Data Science Research Centre, Human Technopole, Milan, Italy.

Abstract

Background

South Asians may be particularly susceptible to premature myocardial infarction (MI) owing both to conventional cardiovascular risk factors and practices distinctive to South Asia. Identifying modifiable risk factors for MI in these populations could inform prevention strategies. We have, therefore, studied conventional risk factors and other characteristics in relation to occurrence of first MI in Bangladesh.

Methods

In a case-control study involving 8133 first-onset MI cases and 8124 controls recruited in Bangladesh, we calculated odds ratios (ORs) for MI adjusted, for age, sex, smoking status, history of diabetes, history of hypertension, family history of MI, and LDL-cholesterol. We assessed the potential public health impact of risk factor modification using population attributable fractions (PAFs).

Findings

The median (IQR) age of first MI was 53 (45-60) years. Adjusted ORs (95% CIs) were 2.80 (2.57-3.05) for cigarette smoking, 2.17 (1.94-2.43) for family history of MI, 2.27 (2.07-2.48) for history of hypertension, 1.91 (1.72-2.13) for history of diabetes, and 1.53 (1.47-1.58) per 1-SD higher LDL-cholesterol. The highest PAFs (95% CIs) were with current cigarette smoking (49% [46%-52%]), higher LDL-cholesterol (31% [29%-33%]) and history of hypertension (15% [13%-16%]). As for regionally distinctive practices, ORs were 4.02 (3.13-5.17) with smoking, 2.09 (1.52-2.87) with chewing tobacco, and 1.26 (1.05-1.51) with parental history of first-cousin marriage.

Interpretation

Our results confirm the relevance of several conventional risk factors to risk of first MI in Bangladesh, and identify associations with MI of practices distinctive to South Asia, including indigenous modes of tobacco consumption and parental first-cousin marriage. These findings suggest opportunities for cardiovascular disease prevention in Bangladesh that embrace both conventional and regionally distinctive risk factors.

Funding

The BRAVE Study Coordinating Centre is underpinned by grants from the British Heart Foundation, UK Medical Research Council and National Institute for Health Research Cambridge Biomedical Research Centre.

MeSH

Diabetes Mellitus, Hypertension, Cigarette Smoking, Myocardial Infarction, Case-Control Studies, Cholesterol, Marriage, Risk Factors, Tobacco Use, History, Smoking