Investigating Genetic and Other Determinants of First-Onset Myocardial Infarction in Malaysia: Protocol for the Malaysian Acute Vascular Events Risk Study
Authors: Chowdhury Rajiv , Noh Mohd Fairulnizal Md , Ismail Sophia Rasheeqa , van Daalen Kim Robin , Kamaruddin Puteri Sofia Nadira Megat , Zulkiply Siti Hafizah , Azizul Nur Hayati , Khalid Norhayati Mustafa , Ali Azizan , Idris Izyan Mohd , Mei Yong Shih , Abdullah Shazana Rifham , Faridus Norfashihah , Yusof Nur Azirah Md , Yusoff Nur Najwa Farahin M , Jamal Rahman , Rahim Aizai Azan Abdul , Ghapar Abdul Kahar Abdul , Radhakrishnan Ammu Kutty , Fong Alan Yean Yip , Ismail Omar , Krishinan Saravanan , Lee Chuey Yan , Bang Liew Houng , Mageswaren Eashwary , Mahendran Kauthaman , Amin Nor Hanim Mohd , Muthusamy Gunavathy , Jin Aaron Ong Hean , Ramli Ahmad Wazi , Ross Noel Thomas , Ruhani Anwar Irawan , Yahya Mansor , Yusoff Yusniza , Abidin Siti Khairani Zainal , Amado Laryssa , Bolton Thomas , Weston Sophie , Crawte Jason , Ovenden Niko , Michielsen Ank , Monower Md Mostafa , Mahiyuddin Wan Rozita Wan , Wood Angela , Di Angelantonio Emanuele , Sulaiman Nur Suffia , Danesh John , Butterworth Adam S 
Published: October 2021

Background
Although the burden of premature myocardial infarction (MI) is high in Malaysia, direct evidence on the determinants of MI in this multi-ethnic population remains sparse.

Objective
The Malaysian Acute Vascular Events Risk (MAVERIK) study is a retrospective case-control study established to investigate the genomic, lipid-related, and other determinants of acute MI in Malaysia. In this paper, we report the study protocol and early results.

Methods
By June 2019, we had enrolled approximately 2500 patients with their first MI and 2500 controls without cardiovascular disease, who were frequency-matched by age, sex, and ethnicity, from 17 hospitals in Malaysia. For each participant, serum and whole blood have been collected and stored. Clinical, demographic, and behavioral information has been obtained using a 200-item questionnaire.

Results
Tobacco consumption, a history of diabetes, hypertension, markers of visceral adiposity, indicators of lower socioeconomic status, and a family history of coronary disease were more prevalent in cases than in controls. Adjusted (age and sex) logistic regression models for traditional risk factors indicated that current smoking (odds ratio [OR] 4.11, 95% CI 3.56-4.75; P<.001), previous smoking (OR 1.34, 95% CI 1.12-1.60; P=.001), a history of high blood pressure (OR 2.13, 95% CI 1.86-2.44; P<.001), a history of diabetes mellitus (OR 2.72, 95% CI 2.34-3.17; P<.001), a family history of coronary heart disease (OR 1.28, 95% CI 1.07-1.55; P=.009), and obesity (BMI >30 kg/m2; OR 1.19, 95% CI 1.05-1.34; P=.009) were associated with MI in age- and sex-adjusted models.

Conclusions
The MAVERIK study can serve as a useful platform to investigate genetic and other risk factors for MI in an understudied Southeast Asian population. It should help to hasten the discovery of disease-causing pathways and inform regionally appropriate strategies that optimize public health action.

International Registered Report Identifier (IRRID)
RR1-10.2196/31885