Temporal Trends in Acute Coronary Syndrome Mortality in Serbia in 2005–2019: An Age–Period–Cohort Analysis Using Data from the Serbian Acute Coronary Syndrome Registry (RAACS)

Abstract

Background: Cardiovascular diseases ranked first in terms of the number of deaths in Serbia in 2019, with 52,663 deaths. One fifth of those were from ischemic heart disease (IHD), and half of IHD deaths were from acute coronary syndrome (ACS). We present the ACS mortality time trend in Serbia during a 15-year period using the latest available data, excluding the COVID-19 pandemic. Methods: The data on patients who died of ACS in the period from 2005 to 2019 were obtained from the National Statistics Office and processed at the Department of Prevention and Control of Non-communicable Diseases of the Institute of Public Health of Serbia. Number of deaths, crude mortality rates (CR) and age-standardized mortality rates (ASR-E) for the European population were analyzed. Using joinpoint analysis, the time trend in terms of annual percentage change (APC) was analyzed for the female and male population aged 0 to 85+. Age–period–cohort modeling was used to estimate age, cohort and period effects in ACS mortality between 2005 and 2019 for age groups in the range 20 to 90. Results: From 2005 to 2019 there were 90,572 deaths from ACS: 54,202 in men (59.8%), 36,370 in women (40.2%). Over the last 15 years, the number of deaths significantly declined: 46.7% in men, 49.5% in women. The annual percentage change was significant: −4.4% in men, −5.8% in women. Expressed in terms of APC, for the full period, the highest significant decrease in deaths was seen in women aged 65–69, −8.5%, followed by −7.6% for women aged 50–54 and 70–74. In men, the highest decreases were recorded in the age group 50–54, −6.7%, and the age group 55–59, −5.7%. In all districts there was significant decline in deaths in terms of APC for the full period in both genders, except in Zlatibor, Kolubara and Morava, where increases were recorded. In addition, in Bor and Toplica almost no change was observed over the full period for both genders. Conclusions: In the last 15 years, mortality from ACS in Serbia declined in both genders. The reasons are found in better diagnostic and treatment through an organized network for management of ACS patients. However, there are districts where this decline was small and insignificant or was offset in recent years by an increase in deaths. In addition, there is space for improvement in the still-high mortality rates through primary prevention, which at the moment is not organized.

Long-Term Prognosis after ST-Elevation Myocardial Infarction in Patients with Premature Coronary Artery Disease

“…Despite major advances in the prevention and treatment of atherosclerosis, the incidence of coronary artery disease (CAD) is increasing in many regions of the world and is starting at an earlier age [ 1 , 2 , 3 , 4 ]. A significant percentage of younger patients with acute myocardial infarction (AMI) have premature CAD [ 5 , 6 ].…”

Comparative assessment of erythrocyte sphingolipid levels as potential cardiovascular health markers in women from Libya and Serbia: a small-scale study

“…Similarly, according to the 2017-year statistics, CVD accounted for 45% and 37% of all deaths in Europe and European Union, respectively [ 4 ]. According to a recent study, in 2019 CVD represented the major cause of death in Serbia accounting for 51.8%, while 17.7% died from ischemic heart disease [ 5 ]. Considering that cardiovascular diseases are the main cause of morbidity and mortality in their country, the Libyan Cardiac Society recently recommended that cardiovascular diseases should be given high priority in the health system to develop a program for efficient prevention, early diagnosis, and treatment [ 6 ].…”