Abstract 13291: Twenty-Two Year Trends in Incidence of Myocardial Infarction, CHD Mortality, and Case-Fatality in Four US Communities, 1987 to 2008
Knowledge of trends in the incidence of and survival after myocardial infarction (MI) in a community setting is important to understanding national trends in coronary heart disease (CHD) mortality rates. We determine race and gender specific trends from 1987 through 2008 in the incidence of MI, case-fatality and CHD mortality in four communities in the United States.
Methods: We conducted community-wide surveillance and validation of hospital discharges for MI and of in- and out-of-hospital death due to CHD among 35 to 74 year old residents of four communities in the Atherosclerosis Risk in Communities (ARIC) Study. Measures of trends included average annual percent change in age- and biomarker-adjusted rates of hospitalized MI or fatal CHD among patients with no prior history of MI. Trends in ST segment MI and non-ST segment MI were also measured as was 28-day and one-year case fatality after discharge.
Results: Over the 22 years, CHD death rates 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. After accounting for age and shifts in biomarkers overtime, the average annual rate of incident hospitalized MI decreased 4.3 percent among white men, 3.8 percent among white women, 2.9 percent black women, and 1.5 percent among black men. Declines in rates of ST segment MI were greater than those observed for non-ST segment MI. Declines in CHD mortality rates and MI incidence were greater in the second decade (1997-2008) compared to the first (1987-1996). Failure to account for biomarker shifts over time would have masked declines in incidence, particularly among blacks. Trends in age adjusted 28-day case-fatality after hospitalized MI were similar in the two decades, declining an average 4.2 percent per year in 1987-1996 and 3.7 percent per year in 1997-2008 in men.
Conclusions: From 1987 through 2008 we observed significant declines in the incidence of MI, primarily due to downward trends in event rates seen between 1997 and 2008. Rates of both in- and out-of-hospital CHD death declined significantly throughout the study period. Accelerating declines MI incidence marks the impact of primary prevention efforts in the United States in the past decade.
- Myocardial infarction
- Myocardial infarction, NSTEMI
- Myocardial infarction, STEMI
- 2020 Goals
- © 2011 by American Heart Association, Inc.