Twenty-Two–Year Trends in Incidence of Myocardial Infarction, Coronary Heart Disease Mortality, and Case Fatality in 4 US Communities, 1987–2008

Abstract

Background Knowledge of trends in the incidence of and survival after myocardial infarction (MI) in a community setting is important to understanding trends in coronary heart disease (CHD) mortality rates. Methods and Results We estimated race and gender specific trends in the incidence of hospitalized MI, case-fatality and CHD mortality from community-wide surveillance and validation of hospital discharges and of in- and out-of-hospital deaths among 35 to 74 year old residents of four communities in the Atherosclerosis Risk in Communities (ARIC) Study. Biomarker adjustment accounted for change from reliance on cardiac enzymes to widespread use of troponin measurements overtime. Between 1987 and 2008, a total of 30,985 fatal or non-fatal hospitalized acute MI events occurred. Rates of CHD death among persons without a history of MI fell an average 4.7 percent per year among men and 4.3 percent per year among women. Rates of both in- and out-of-hospital CHD death declined significantly throughout the period. Age- and biomarker adjusted average annual rate of incident MI decreased 4.3 percent among white men, 3.8 percent among white women, 2.9 percent among black women, and 1.5 percent among black men. Declines in CHD mortality and MI incidence were greater in the second decade (1997–2008). Failure to account for biomarker shift would have masked declines in incidence, particularly among blacks. Age-adjusted 28-day case-fatality after hospitalized MI declined 4.2 percent per year among white men and 3.6 percent per year among black men, 2.6 percent per year among white women, and 2.4 percent per year among black women. Conclusions Although these findings from 4 communities may not directly generalize to blacks and whites in the entire US, we observed significant declines in MI incidence, primarily due to downward trends in rates between 1997 and 2008.

Association of Race and Sex with Risk of Incident Acute Coronary Heart Disease Events

“…The low risk in black men remained present in the fully adjusted models, but the excess risk observed among black women was entirely attenuated after accounting for their higher cardiovascular disease risk factor burden. The high risk of presenting with death as the first manifestation of CHD among black men and women, which is associated with excess burden of cardiovascular disease risk factors, is similar to past reports [4][5][6][7] and demonstrates little evidence of progress toward eliminating this disparity.…”

“…[5][6] Furthermore, data from Kaiser Permanente suggested that hospitalizations for MI decreased between 2002 and 2007, 7 but more so for whites than for blacks. Neither death certificate data nor health plan data permit examination of incident events.…”

“…Neither death certificate data nor health plan data permit examination of incident events. 5,[8][9][10] Two other major secular trends may influence contemporary estimates of incident CHD. First, statins have come into wide use over the past 10 years, 11 lowering incidence rates.…”

Public Health in Primary Care

“…Despite the need of further improvement, mortality for CVDs and in some ways diabetes in various Western countries has reached overall good results [WHO 2011, Reaven 2011, Rosamond 2012], thanks to the health care resources allocated and the public health campaigns deployed over the past years. By contrast, in many developing countries type II diabetes is growing at epidemic levels [Hu 2011, Lam 2012.…”

A Descriptive Study on Risk Factors among Acute Myocardial Infarction Patients Admitted to the Coronary Care Unit of Prince Mitab Hospital Sakaka Aljouf

“…About 50%-70% of ischemic heart disease is represented by myocardial infarction (MI) and MI continues to be the leading morbidity for hospital admissions. [10][11] Many factors have been identified related to MI that includes National Journal of Research in Community Medicine│Oct-Dec 2017│ Vol 6 │Issue 4│…”