A large international study linked more than 90% of heart attacks to nine easy-to-measure risk factors common to essentially every region and ethnic group around the globe. 'The risk factors are the same all over the planet,' said Jean-Pierre Bassand, president of the European Society of Cardiology. 'Political action is desperately needed' in all countries to devise plans geared toward prevention, he said.

The study, led by Salim Yusuf, director of the Population Health Research Institute at McMaster University, Hamilton, Ontario, included 15,152 patients from 52 countries who suffered a first heart attack and compared them with 14,820 people from their respective regions who were closely matched in age and gender but hadn't had a heart attack. All of the participants were evaluated for nine risk factors:

1. cholesterol abnormalities
2. smoking
3. diabetes
4. weight
5. depression and stress
6. high blood pressure
7. diet
8. exercise
9. alcohol consumption

Using those nine measures, 'we can predict virtually all of the risk' of cardiovascular disease, Dr. Yusuf said. Dr. Yusuf proposed regulations controlling food advertising and urban planning to promote more physical activity to help combat the problem.

The study found abnormal cholesterol, as measured by a ratio of proteins called ApoB and ApoA-1, accounted for nearly 50% of the risk for heart attacks in the population. Smoking and abdominal obesity were among other top predictors of cardiovascular disease. Depression and stress, which were determined from several different questionnaires used in the study, accounted for a 2.5-fold risk in a person's risk of a heart attack. Regular consumption of fruits and vegetables was associated with a 30% reduction of an individual's risk of a heart attack; regular exercise and moderate alcohol consumption lowered risk by 14% and 9%, respectively.