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1Institute of Preventive and Clinical Medicine, Bratislava, Slovakia (emeritus), and 2State University of New York, Downstate Medical Center at Brooklyn, USA Address for correspondence: E. Ginter, RND, DSc, Racianska 17, SK83102 Bratislava, Slovakia The incidence of cardiovascular disease (CVD) is increasing rapidly in countries with low and middle income. That part of the world accounts for an estimated 80 % of the global CVD burden. Even worse, CVD in less affl uent countries starts to affect people at younger age. Paradoxically, the CVD risk factors in poor countries are less prominent than in high-income countries. This paradox between low incidence of CVD risk on the one hand and increasing CVD mortality on the other was subjected to critical review of many investigators. In seventeen countries and fi ve continents, they assessed the risk and mortality in more than 156,000 individuals at an average age of fi fty, using the INTERHEART Risk Score. Participants were followed for the incidence of cardiovascular disease and death for a mean of 4.1 years (1). Another INTERHEART study (2) was focused on CVD risk factors. This was a large standardized case–control study involving cases of fi rst myocardial infarction from 52 different countries, compared with their sexand age-matched controls. Nine modi-

More risk factors generate lower mortality – a useful advice for improved health in the world