Churchill L Onen

Publications (3)52.43 Total impact

• Article: Metabolic syndrome and risk of acute myocardial infarction a case-control study of 26,903 subjects from 52 countries.

  Andrew Mente, Salim Yusuf, Shofiqul Islam, Matthew J McQueen, Supachai Tanomsup, Churchill L Onen, Sumathy Rangarajan, Hertzel C Gerstein, Sonia S Anand
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  ABSTRACT: This study examines the risk of acute myocardial infarction (MI) conferred by the metabolic syndrome (MS) and its individual factors in multiple ethnic populations. The risk of the MS on MI has not been well characterized, especially in multiple ethnic groups. Participants in the INTERHEART study (n = 26,903) involving 52 countries were classified using the World Health Organization (WHO) and International Diabetes Federation (IDF) criteria for MS, and their odds ratios (ORs) for MI were compared with the individual MS component factors. The MS is associated with an increased risk of MI, both using the WHO (OR: 2.69; 95% confidence interval [CI]: 2.45 to 2.95) and IDF (OR: 2.20; 95% CI: 2.03 to 2.38) definitions, with corresponding population attributable risks of 14.5% (95% CI: 12.7% to 16.3%) and 16.8% (95% CI: 14.8% to 18.8%), respectively. The associations are directionally similar across all regions and ethnic groups. Using the WHO definition, the association with MI by the MS is similar to that of diabetes mellitus (OR: 2.72; 95% CI: 2.53 to 2.92) and hypertension (OR: 2.60; 95% CI: 2.46 to 2.76), and significantly stronger than that of the other component risk factors. The clustering of > or =3 risk factors with subthreshold values is associated with an increased risk of MI (OR: 1.50; 95% CI: 1.24 to 1.81) compared with having component factors with "normal" values. The IDF definition showed similar results. In this large-scale, multi-ethnic, international investigation, the risk of MS on MI is generally comparable to that conferred by some, but not all, of its component risk factors. The characterization of risk factors, especially continuous variables, as dichotomous will underestimate risk and decrease the magnitude of association between MS and MI.
  Journal of the American College of Cardiology 05/2010; 55(21):2390-8. · 14.16 Impact Factor
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  Available from: Steven Hawken

  Article: Obesity and the risk of myocardial infarction in 27,000 participants from 52 countries: a case-control study.

  Salim Yusuf, Steven Hawken, Stephanie Ounpuu, Leonelo Bautista, Maria Grazia Franzosi, Patrick Commerford, Chim C Lang, Zvonko Rumboldt, Churchill L Onen, Liu Lisheng, Supachai Tanomsup, Paul Wangai, Fahad Razak, Arya M Sharma, Sonia S Anand
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  ABSTRACT: Obesity is a major risk factor for cardiovascular disease, but the most predictive measure for different ethnic populations is not clear. We aimed to assess whether markers of obesity, especially waist-to-hip ratio, would be stronger indicators of myocardial infarction than body-mass index (BMI), the conventional measure. We did a standardised case-control study of acute myocardial infarction with 27 098 participants in 52 countries (12,461 cases and 14,637 controls) representing several major ethnic groups. We assessed the relation between BMI, waist and hip circumferences, and waist-to-hip ratio to myocardial infarction overall and for each group. BMI showed a modest and graded association with myocardial infarction (OR 1.44, 95% CI 1.32-1.57 top quintile vs bottom quintile before adjustment), which was substantially reduced after adjustment for waist-to-hip ratio (1.12, 1.03-1.22), and non-significant after adjustment for other risk factors (0.98, 0.88-1.09). For waist-to-hip ratio, the odds ratios for every successive quintile were significantly greater than that of the previous one (2nd quintile: 1.15, 1.05-1.26; 3rd quintile: 1.39; 1.28-1.52; 4th quintile: 1.90, 1.74-2.07; and 5th quintiles: 2.52, 2.31-2.74 [adjusted for age, sex, region, and smoking]). Waist (adjusted OR 1.77; 1.59-1.97) and hip (0.73; 0.66-0.80) circumferences were both highly significant after adjustment for BMI (p<0.0001 top vs bottom quintiles). Waist-to-hip ratio and waist and hip circumferences were closely (p<0.0001) associated with risk of myocardial infarction even after adjustment for other risk factors (ORs for top quintile vs lowest quintiles were 1.75, 1.33, and 0.76, respectively). The population-attributable risks of myocardial infarction for increased waist-to-hip ratio in the top two quintiles was 24.3% (95% CI 22.5-26.2) compared with only 7.7% (6.0-10.0) for the top two quintiles of BMI. Waist-to-hip ratio shows a graded and highly significant association with myocardial infarction risk worldwide. Redefinition of obesity based on waist-to-hip ratio instead of BMI increases the estimate of myocardial infarction attributable to obesity in most ethnic groups.
  The Lancet 11/2005; 366(9497):1640-9. · 38.28 Impact Factor
• Article: Obesity and the risk of myocardial infarction in 27 000 participants from 52 countries: a case-control study

  Salim Yusuf, Steven Hawken, Stephanie Ôunpuu, Leonelo Bautista, Maria Grazia Franzosi, Patrick Commerford, Chim Lang, Zvonko Rumboldt, Churchill L Onen, Liu Lisheng, Supachai Tanomsup, Paul Wangai, Fahad Razak, Arya M Sharma, Sonia S Anand
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  ABSTRACT: Background Obesity is a major risk factor for cardiovascular disease, but the most predictive measure for different ethnic populations is not clear. We aimed to assess whether markers of obesity, especially waist-to-hip ratio, would be stronger indicators of myocardial infarction than body-mass index (BMI), the conventional measure. Methods We did a standardised case-control study of acute myocardial infarction with 27 098 participants in 52 countries (12 461 cases and 14 637 controls) representing several major ethnic groups. We assessed the relation between BMI, waist and hip circumferences, and waist-to-hip ratio to myocardial infarction overall and for each group. Findings BMI showed a modest and graded association with myocardial infarction (OR 1·44, 95% CI 1·32–1·57 top quintile vs bottom quintile before adjustment), which was substantially reduced after adjustment for waist-to-hip ratio (1·12, 1·03–1·22), and non-significant after adjustment for other risk factors (0·98, 0·88–1·09). For waist-to-hip ratio, the odds ratios for every successive quintile were significantly greater than that of the previous one (2nd quintile: 1·15, 1·05–1·26; 3rd quintile: 1·39; 1·28–1·52; 4th quintile: 1·90, 1·74–2·07; and 5th quintiles: 2·52, 2·31–2·74 [adjusted for age, sex, region, and smoking]). Waist (adjusted OR 1·77; 1·59–1·97) and hip (0·73; 0·66–0·80) circumferences were both highly significant after adjustment for BMI (p<0·0001 top vs bottom quintiles). Waist-to-hip ratio and waist and hip circumferences were closely (p<0·0001) associated with risk of myocardial infarction even after adjustment for other risk factors (ORs for top quintile vs lowest quintiles were 1·75, 1·33, and 0·76, respectively). The population-attributable risks of myocardial infarction for increased waist-to-hip ratio in the top two quintiles was 24·3% (95% CI 22·5–26·2) compared with only 7·7% (6·0–10·0) for the top two quintiles of BMI. Interpretation Waist-to-hip ratio shows a graded and highly significant association with myocardial infarction risk worldwide. Redefinition of obesity based on waist-to-hip ratio instead of BMI increases the estimate of myocardial infarction attributable to obesity in most ethnic groups. The article references also includes three 'Web Extra material' PDF's : Webtable 1. Demographics and prevalence of risk factors in cases and controls in the INTERHEART study.; Webtable 2. Anthropometric measures by region.; INTERHEART Project Office Staff, National Coordinators, and Investigators.