Asian Institute of Research, Journal Publication, Journal Academics, Education Journal, Asian Institute
Asian Institute of Research, Journal Publication, Journal Academics, Education Journal, Asian Institute

Journal of Health and Medical Sciences

ISSN 2622-7258

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open access

Published: 01 August 2019

No Clear Link with Diet and AMI: A Case - Control Study of Risk Factors of Acute Myocardial Infarction Patients in Trinidad

Mandreker Bahall

University of the West Indies, St. Augustine, Trinidad and Tobago

journal of social and political sciences
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Pages: 285-296

Keywords: AMI, Diet, Risks Factors, Sugar, Vegetables, Fats and Oil


Objectives: Dietary risk factors are considered a major determinant of coronary artery disease. However, dietary components resulting in IHD have been mixed and inconsistent. The aim of this study was to determine traditional and dietary risks for acute myocardial infarction. Methodology: This case control study was conducted at a public health care institute. Confirmed AMI cases were matched against hospitalised age and sex matched non-IHD patients. Data collected from face to face interviews were analysed using SPSS version 21. Descriptive and analytic analyses comprising Pearson’s chi squared test of association and conditional logistic regression were conducted. Results: Traditional risk factors such as ischemic heart disease, previous heart attack, diabetes mellitus, hypercholesterolemia, family history of IHD, hypertension, obesity and higher waist circumference increased the odds of AMI. Exercising (less than 4 times a week), alcohol use (frequently) and smoking (frequently) showed significant associations. Overall, there was no association with diet and AMI. However, there were associations identified in certain subgroups with respect to diet and AMI. Predictors of AMI overall were ischemic heart disease, previous heart attack and hypercholesterolemia. Indo-Trinidadians who exercised less than 4 times per week and males who ate less than 3 servings per week had an increased likelihood of having an MI (1.908 times and twice as likely respectively) to have an AMI. Conclusion: Overall, there is no association of diet and AMI. Traditional risk factors still largely determine AMI.


  1. Ahmad , S., Moorthy, M. V., Demler, O. V., Hu, F. B., Ridker, P. M., Chasman, D. I. (2018). Assessment of Risk Factors and Biomarkers Associated With Risk of Cardiovascular Disease Among Women Consuming a Mediterranean Diet. JAMA Netw Open, 1. 

  2. Amani, R., Noorizadeh, M., Rahmanian, S., Afzali, N., Haghighizadeh, M. H. ( 2010). Nutritional Related Cardiovascular Risk Factors in Patients with Coronary Artery Disease in IRAN: A case-control study. Nutrition Journal 9, 70.

  3. American College of Cardiology. (2015). Mediterranean Diet cuts Heart Disease Risk by Nearly Half. Retrieved from:

  4. American Heart Association. Coronary Artery Disease - Coronary Heart Disease. (n.d.) Retrieved from:

  5. Appel, L, J., Moore, T. J., Obarzanek, E., Vollmer, W. M., Svetkey, L. P., Sacks, F. M., … Karanja N. (1997). A Clinical Trial of The Effects of Dietary Patterns on Blood Pressure. DASH Collaborative Research Group. N Engl J Med,  336, 1117–1124.

  6. Bahall M. Epidemology of Acute Myocardial Infarction in South Trinidad. (2013). WIMJ Open, 3, 1-6. Doi:10.7727/wimjopen.2013.215.

  7. Barcelo, A. Cardiovascular diseases in Latin America and the Caribbean.  (2006). Lancet, 368: 625–6. DOI:10.1016/S0140-6736(06)69223- 4.

  8. Bazzano, L., He, J., Ogden, L., Loria, C., Vupputuri, S., Myers, L., … Whelton, P. K. (2002). Fruit and Vegetable Intake and Risk of Cardiovascular Disease in US adults: The First National Health and Nutrition Examination Survey Epidemiologic Follow-up Study. The American Journal of Clinical Nutrition, 76, 93-9.

  9. Bechlioulis, A., Vakalis, K., Naka, K. K., Bourantas, C. V., Papamichael, N. D., Kotsia, A., … Michalis, L. K.. (2013). Paradoxical Protective Effect of Central Obesity in Patients with Suspected Stable Coronary Artery Disease. Obesity (Silver Spring), 21, 314-21.

  10. Burns-Coxt, C. J., Dollt, R., Ball, K. P. (1969). Sugar Intake and Myocardial Infarction Brit. Heart, 31.

  11. ChartsBin. (n. d. -a). Contribution of carbohydrates in total dietary consumption.Retrieved from:

  12. ChartsBin. (n. d.-b). Daily fat intake per capita. Retrieved from:

  13. Dauchet, L., Amouyel, P., Hercberg, S., Dallongeville, J. (2006). Fruit and Vegetable Consumption and Risk of Coronary Heart Disease: A Meta-Analysis of Cohort Studies. The Journal of Nutrition, 136.

  14. Dehghan, D., Mente, A., Zhang, X., Swaminathan, S., Li, W., Mohan, V., …Yusuf, S. (2017). Associations of Fats and Carbohydrate Intake with Cardiovascular Disease and Mortality in 18 Countries from Five

  15. Continents (PURE): A Prospective Cohort Study. Lancet. 390, 2050–62.

  16. Fung, T. T., Rexrode, K. M., Mantzoros , C. S., Manson , J. E., Willett, W. C., Hu, F. B. (2009). Mediterranean Diet and Incidence of and Mortality From Coronary Heart Disease and Stroke in Women. Circulation, 119:1093–1100. 

  17. Guo, J., Li, W., Wang, Y., Chen, T., Teo, K., Liu, L. S., … Yusuf, S. (2013). Influence of Dietary Patterns on the Risk of Acute Myocardial Infarction in China population: The INTERHEART China Study. Chin Med J (Engl), 126, 464-70.  

  18. He, F., Nowson, C., Lucas, M., MacGregor, G. (2007). Increased Consumption of Fruit and Vegetables is related to a Reduced Risk of Coronary Heart Disease: Meta-analysis of Cohort Studies. Journal of Human Hypertension , 21, 717-728.

  19. . (n. d.). Added sugars. Retrieved from:

  20. HelgiLibrary (n. d. -a). Sugar consumption per capita in Trinidad and Tobago.  Retrieved from:

  21. HelgiLibrary. (n. d. -b). Animal fat consumption (total) in Trinidad and Tobago [Internet]. Retrieved from:

  22. Indexmundi . (n. d.). Trinidad and Tobago centrifugal sugar human domestic consumption by year (1000 MT). Retrieved from:

  23. Iqbal, R., Anand, S., Ounpuu, S., Islam, S., Zhang, X., Rangarajan, S., … Yusuf, S. (2008). Dietary Patterns and the Risk of Acute Myocardial Infarction in 52 Countries Results of the INTERHEART Study. Circulation.  

  24. Johnston, C. (2009).  Functional Foods as Modifiers of Cardiovascular Disease. American Journal of Lifestyle Medicine, 3, 39S-43S.

  25. Joshipura, K., Hu, F., Manson, J., Stampfer,  M., Rimm, E., Speizer, F., … Willett, W. C. (2001). The Effect of Fruit and Vegetable Intake on Risk for Coronary Heart Disease. Ann Intern Med, 134, 1106-1114.

  26. Kim, J. I. (2016). Saturated Fatty Acid Intakes and the Risk of Myocardial Infarction in Women: A Prospective Cohort.

  27. Liu, S., Manson, J., Lee, I., Cole, S., Hennekens, C., Willett, W., … Buringet, J. E. (2000). Fruit and Vegetable Intake and Risk of Cardiovascular Disease: The Women's Health Study. The American Journal of Clinical Nutrition, 72.

  28. Ministry of Health. (2012).Trinidad. Utilisation Report of the Medical Records Department. South West Regional Health Authority.

  29. Rao, V., Rao, P., Carvalho, N. (2014). Risk factors for Acute Myocardial Infarction in Coastal Region of India: A Case-control Study. Heart India 2, 70-5.  

  30. Rastogi, T., Reddy, K. S., Vaz, M., Spiegelman, D., Prabhakaran, D., Willett, W. C., … Ascherio, A. (2004). Diet and Risk of Ischemic Heart Disease in India. Am J Clin Nutr 79, 582–92.

  31. Rippe, J., Angelopoulos, T. (2016). Relationship between Added Sugars Consumption and Chronic Disease Risk Factors: Current Understanding. Nutrients, 8, 697.

  32. Sacks, F. M., Lichtenstein, A. H., Wu, J. H. Y. (2017). Dietary Fats and Cardiovascular Disease: A Presidential Advisory.  The American Heart Association , 136, e1–e23.  

  33. Saita, E., Kondo, K., Momiyama, Y. (2014). Anti-Inflammatory Diet for Atherosclerosis and Coronary Artery Disease: Antioxidant Foods. Clin Med Insights Cardiol, 8, 61–65.

  34. Saleheen, D., Frossard, P. CAD risk factors and acute myocardial infarction in Pakistan. Acta Cardiol, 59, 417-24.  

  35. Siddiqui, A. H., Gulati, R., Tauheed, N., Pervez, A. (2014). Correlation of Waist-to-hip Ratio (WHR) and Oxidative Stress in Patients of Acute Myocardial Infarction (AMI). Journal of Clinical and Diagnostic Research 8, 4-7.

  36. Singh, G., Micha, R., Khatibzadeh, S.,  Shi, P., Lim, S., Andrews, K., … Mozaffarian, D. (2015). Global, Regional, and National Consumption of Sugar-Sweetened Beverages, Fruit Juices, and Milk: A Systematic Assessment of Beverage Intake in 187 Countries. PLOS ONE, 10.

  37. Teo, K. K., Ounpuu, S., Hawken, S., Pandey, M.R., Valentin, V., Hunt, D., …Yusuf, S. Tobacco use and risk of myocardial infarction in 52 countries in the INTERHEART study: a case-control study.  (2006). Lancet, 368, 647–58.

  38. Wald, D. S., Law, M., Morris, J. K. ( 2002). Homocysteine and Cardiovascular Disease: Evidence on Causality from a Meta-analysis. BMJ, 325, 1202–1206.

  39. Wang, J., Yang, Y. M., Zhu, J., Zhang, H., Shao, X. H. Obesity Paradox in Patients with Atrial Fibrillation and Heart Failure. (2014). Int J Cardiol, 176, 1356-8.  

  40. World Health Organization. (n. d.). Healthy diet. Retrieved from:

  41. Yang, Q., Zhang, Z., Gregg, E., Flanders, W., Merritt, R., Hu, F. (2014). Added Sugar Intake and Cardiovascular Diseases Mortality Among US Adults. JAMA Internal Medicine, 174, 516. 

  42. Yudkin, J. (1986). Pure, white and deadly.,%20White%20and%20Deadly%20-%20%20John%20Yudkin.pdf

  43. Zimmerman, J., Fromm, R., Meyer, D., Boudreaux, A., Wun, C. C., Smalling, R., … Roberts, R. Diagnostic Marker Cooperative Study for the Diagnosis of Myocardial Infarction. (1999). Circulation, 99, 1671-7.

  44. Zong, G.,  Li, Y., Wanders, A. J., Alssema, M., Zock, P. L., Willett, W. C., … Sun, Q. (2016). Intake of Individual Saturated Fatty Acids and Risk of Coronary Heart Disease in US Men and Women: Two Prospective Longitudinal Cohort Studies. BMJ, 355.