Divergent trends in the incidence and mortality of acute myocardial ischaemic syndrome, especially in women. Evidence from Finland in 1996-2021

Ann Med. 2024 Dec;56(1):2424455. doi: 10.1080/07853890.2024.2424455. Epub 2024 Nov 26.

Abstract

Objective: Although the incidence and case fatality (CF) of acute myocardial ischaemic syndrome (AMIS) have declined in recent decades, some studies have suggested a potential stagnation in this decline. We examined if a similar development in AMIS trends can be observed in Finland from 1996 to 2021 among persons aged 35-74 years.

Methods: We linked Finnish country-wide Hospital Discharge- and Causes of Death- Registers covering the first non-fatal and fatal myocardial ischaemic events (total 69 906 442 person-years at risk). We analyzed the incidence, mortality, and 28-day CF and their trends using negative binomial, Poisson, segmented and logistic regression adjusting for age and sex.

Results: The analysis consisted of 186 489 non-fatal and 72 907 fatal myocardial ischaemic events. AMIS incidence declined in men (annual percentage change (APC) -2.0%) and in older women (APC of 55-64 years -1.5%; 65-74 years -3.3%) during the study period. However, the incidence decline slowed down over the last decade in oldest age groups and stopped overall in women. Incidence was unchanged during the study period in younger women aged 35-54 years. AMIS mortality and CF declined (APC of mortality in men -4.4%; in women -5.0%; APC of CF in men -2.7%; in women -3.3%).

Conclusions: AMIS mortality declined in all groups, but the decline in AMIS incidence slowed down and even stopped in women. Incidence was unchanged during the study period in women aged 35-54 years. These results emphasize the need for further efforts in prevention of cardiovascular disease, particularly in young and middle-aged women.

Keywords: acute myocardial ischaemic syndrome; epidemiology; incidence; mortality; women.

Plain language summary

What is already known on this topic – Coronary heart disease treatment and prevention have improved worldwide in recent decades, which has led to a decline in AMIS mortality and case fatality. However, recent studies from several countries suggest that the incidence decline has stagnated or even started to increase, especially in younger age cohorts.What this study adds – This study showed that the incidence decline has stopped in women aged 35-54 years and has slowed down in older age groups. Together with declining mortality, this results in a growing number of patients living with cardiovascular disease, leading to increased healthcare costs.How this study might affect research, practice, or policy – The results of this study underline the importance of intensifying prevention of cardiovascular disease, with a focus especially on young and middle-aged women.

MeSH terms

  • Adult
  • Age Distribution
  • Aged
  • Female
  • Finland / epidemiology
  • Humans
  • Incidence
  • Male
  • Middle Aged
  • Mortality / trends
  • Myocardial Ischemia* / epidemiology
  • Myocardial Ischemia* / mortality
  • Registries
  • Sex Distribution
  • Sex Factors

Grants and funding

M.R. received support from the Sigrid Juselius Foundation, the Emil Aaltonen Foundation, the Biomedicum Helsinki Foundation, the Orion Research Foundation, and from the Finnish Foundation for Cardiovascular Research. V.S. was supported by the Juho Vainio Foundation. I.H. was supported by the Aarne Koskelo Foundation, the Otto A. Malm Foundation, and the Finnish Foundation for Cardiovascular Research.