INTRODUCTIONThe Framingham Risk Score (FRS) is a well-validated epidemiologic tool used to assess the risk for a fi rst cardiac event. Because young patients presenting with a fi rst myocardial infarction (MI) tend to have less significant risk profiles compared with older patients, we hypothesized that FRS may underestimate cardiac risk in these patients.

MATERIALS AND METHODSWe studied 1267 patients between January 2002 and November 2007 presenting with a fi rst MI. Patients with pre-existing diabetes mellitus and vascular disease were excluded. FRS was calculated for each patient. Patients were divided based on their age: group A (<40 years), group B (40 to 64 years) and group C (> or =65 years).

RESULTSThe mean age was 54.7 +/- 11 years, 88.4% of the patients were males. Younger patients were more likely to be assigned with lower scores. Based on FRS, 63.0%, 29.3% and 14.2% of group A, B and C patients were classified as low risk (10-year risk for cardiac events<10%) respectively, P <0.001. The sensitivity of FRS in identifying at least intermediate risk subjects (10-year risk for cardiac events >10%) was 37.0% in group A vs 85.8% in group C (P <0.001). The incidence of newly diagnosed diabetes mellitus was higher in younger patients (12.0% vs 13.2% vs 7.1 % in groups A, B and C respectively, P = 0.027).

CONCLUSIONSFRS inadequately predicts cardiac risk in young patients presenting with a fi rst MI. This could be because a significant proportion of these young patients have undiagnosed diabetes mellitus, a coronary artery disease risk equivalent.

Adult ; Age Factors ; Aged ; Algorithms ; Diabetes Complications ; Female ; Humans ; Male ; Middle Aged ; Myocardial Infarction ; complications ; diagnosis ; Retrospective Studies ; Risk Assessment ; Risk Factors ; Sex Factors

Nutrition information on food labels guides consumers to purchase healthier food choices. Besides nutrition information, other factors influence a purchase. This study aims to determine the association between the knowledge, attitude, and practice (KAP) among tertiary students on nutrition and food labels. In this cross-sectional study, a total of 190 students from three tertiary institutions within Klang Valley completed an online survey. Self-administered questionnaires on sociodemographic profiles and KAP questions, available in Malay and English, were distributed. Association between KAP was determined using Spearman's Rho test, while multiple linear regression was used to assess predictors of KAP scores. Mean body mass index (BMI) of the respondents were 20.8 kg/m2. The total mean score for knowledge on food labels was 8.93, followed by attitude and practice with 3.86 and 3.11, respectively. There was a significant correlation between attitude and practice (p<0.005). Nutrient and total calorie information on food labels influenced purchases, with 56.3% of respondents reported looking at the total calorie content, followed by 55.7% and 49.5% checking on sugar and fats, respectively. In addition, other factors such as expiry date (60.9%) and price (59.9%) also influenced purchases. Overall, respondents have a positive attitude on food selection, but male respondents have better knowledge levels than females. However, female respondents interpret food labelling effectively compared to male respondents. Despite having good knowledge and attitude towards nutrition, respondents were still making poor choices. A more extensive range of healthier food options and targeted healthy eating campaigns may empower students to choose more nutritious foods.