Abstract 1034: Population Trends in the Incidence of Acute Coronary Heart Disease: The Minnesota Heart Survey
Introduction: Age-adjusted mortality rates for coronary heart disease (CHD) continue to decline. And there is increasing CHD prevalence resulting from improving survival from acute care and the movement of the epidemic into older age groups. However, trends in incidence and recurrence, most likely the result of primary and secondary prevention, are not well studied.
Hypothesis: Population trends in acute CHD incidence and recurrence are declining.
Methods: The Minnesota Heart Survey abstracted hospital admissions for patients age 30 –74 with acute coronary syndromes in the Minneapolis-St. Paul metropolitan area (population 2.85 million) since 1985. The American Heart Association (AHA-2003) diagnostic algorithm was applied to patients with a discharge diagnosis of acute myocardial infarction (AMI) (ICD-9 410) or unstable angina (ICD-9 411) to validate an AMI case. Cases were stratified into incident or recurrent based on hospital record review.
Results: From 1985 to 2001, 5932 cases were abstracted. Cases with a discharge diagnosis of AMI or unstable angina (410 and 411) fell 17% for men and 15% for women. Attack rate for validated AMI fell 13% for men and 3% for women. Correction of rates for the more sensitive biomarker troponin, reduced event rates in 2001 resulting in larger declines in incident and recurrent events. From 1985 to 2001, incidence fell 42% in men and 39% in women. Recurrence fell 57% in men and 69% in women.
Conclusions: Using a standard definition and correction for troponin, incident and recurrent AMI are falling, particularly in the most recent period, suggesting that primary and secondary prevention play an increasing role in population trends.