ABSTRACT
Atherosclerosis depends on the interplay between genetic, behavioral, and environmental factors. However, the landmark INTERHEART study (1) and other large-scale population studies have established that over a life course this is a largely preventable process. The INTERHEART study showed that approximately 85% of the variation in rates of myocardial infarction (MI) was associated with nine risk factors. Of these, population-attributable risk both for older and younger subjects was highest for the ratio of apolipoprotein B/apolipoprotein A1. This ratio is a measure of atherogenic particle number [apolipoprotein B, superior to low-density lipoprotein (LDL) cholesterol concentration alone] and antiatherogenic particles [apolipoprotein A1, reflecting high-density lipoprotein (HDL) cholesterol]. Elevated blood cholesterol, considered to be greater than 147 mg/dL (3.8 mmol/L), was also found to be the leading risk factor for coronary heart disease (CHD), and estimated to account for more than half of cases worldwide in the recent World Health Report (2).
