There are numerous lifestyle, dietary, and genetic factors believed to play a part in heart disease and it can be difficult to determine which of these factors are the most important ones. According to a report published in the journal Lancet in 2004, there are just nine risk factors that account for the overwhelming majority of heart attacks. The good news is that each of the risk factors identified is preventable.
The study, conducted by Canadian scientists, involved analyzing 262 previous studies on heart disease involving a combined 29,000 individuals from 52 countries. The researchers attempted to isolate the risk factors thought to have the greatest impact on an individuals probability of suffering a heart attack.
The researchers found that nine modifiable risk factors accounted for more than 90% of all heart attack cases. The risk factors were (in descending order to importance):
- A high ApoB/ApoA-1 ratio
- Current smoking
- Psychosocial factors (e.g work stress)
- Hypertension (high blood pressure)
- Abdominal obesity
- Poor fruit and vegetable intake
- Lack of physical activity
- Little or no consumption of alcohol
The ApoB/ApoA-1 ratio is similar to the LDL/HDL ratio but is thought to be a better overall predictor of heart disease. The odds of suffering a heart attack were 3.25 times greater for individuals with an ApoB/ApoA-1 ratio in the top 20% compared to the bottom 20% and were 2.87 times greater for current smokers compared to former or non smokers. The full odds ratios for each of the factors are shown in the graph below (an odds ratio greater than one indicates an increased risk of heart attack while an odds ratio less than one indicates a reduction in heart attack risk).
The two greatest risk factors, a high ApoB/ApoA-1 ratio and smoking, were calculated to be responsible for a massive 67.3% of all heart attacks worldwide. The nine factors combined were responsible for 90% of all heart attacks in men and 94% of heart attacks in women.
According to lead researcher Dr. Salim Yusuf of the Michael DeGroote School of Medicine in Ontario, Canada: “…most people believe that only half the risk of heart attacks can be predicted. This study convincingly shows that 90% of the global risk is preventable.”
The researchers added that while obesity was an established heart attack predictor, it was not included as one of the risk factors because it performed relatively poorly compared to abdominal obesity. This is because fat located around the central organs appears to be much more problematic for the heart than fat located in other areas. The authors recommend people place less emphasis on BMI and instead use a measure of central obesity such as waist size or the waist to hip ratio to more accurately gauge heart disease risk.
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