Despite more than 80% of the global burden of cardiovascular diseases now occurring in low and middle income countries,1 most of what we know about the causes of these diseases comes from studies of populations in North America and western Europe. Many of the resulting clinical and public health policies in these high income regions are being applied in lower income regions, but perhaps sometimes inappropriately, since many lower income countries have physical, social and economic environments that are substantially different from those in richer parts of the world. Helping to close this gulf in cardiovascular knowledge is the INTERHEART case-control study. Spread across one quarter of the world’s countries, including 30 or so lower and middle income countries, the study is a unique resource for assessing causes of coronary heart disease in different contexts.2-5 For this reason, and because of its sheer size (12 000 cases of acute myocardial infarction [MI] and 15 000 controls), INTERHEART has rightly become a landmark study.
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