To the Editor: Dr Joshi and colleagues1 analyzed risk factors for early acute myocardial infarction among natives of South Asian countries. The study identified 9 risk factors that account for the majority of cases of acute myocardial infarction in both South Asian and other countries. One important factor that was not addressed was whether the South Asian participants were from urban or rural settings. Results from urban centers should not be generalized to the populations as a whole in these countries. As an example, in Bangladesh (which was identified as the country with the highest prevalence of acute myocardial infarction risk factors), the majority of the population lives in rural areas. Compared with its urban counterpart, the rural population in Bangladesh has been characterized as having higher energy expenditure due to higher work-related labor and heavy household duties.2 Furthermore, the rural diet is rich in vegetables and poorer in meat.3 The opposite is true in urban settings.4 This study needs to address this distinction.
Rashid S, Khandaker N. Risk Factors for Early Myocardial Infarction in South Asians. JAMA. 2007;297(17):1880–1881. doi:10.1001/jama.297.17.1880-b
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