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.
In addition, in Bangladesh millions of individuals are consuming arsenic-contaminated groundwater, both for drinking and for cooking purposes.5 Long-term consumption of arsenic-contaminated water is a risk factor for cardiovascular disease.6 The effect of arsenic in the drinking water in parts of South Asia could be an important risk factor contributing to the high prevalence of cardiovascular disease in the region.
Financial Disclosures: None reported.
Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature
Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal
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