Twenty-two-year trends in incidence of myocardial infarction, coronary heart disease mortality, and case fatality in 4 US communities, 1987-2008

Wayne D. Rosamond, Lloyd E. Chambless, Gerardo Heiss, Thomas H. Mosley, Josef Coresh, Eric Whitsel, Lynne Wagenknecht, Hanyu Ni, Aaron R. Folsom

Research output: Contribution to journalArticle

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 4 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 over time. During 1987-2008, a total of 30 985 fatal or nonfatal hospitalized acute MI events occurred. Rates of CHD death among persons without a history of MI fell an average 4.7%/y among men and 4.3%/y 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% among white men, 3.8% among white women, 3.4% among black women, and 1.5% 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 3.5%/y among white men, 3.6%/y among black men, 3.0%/y among white women, and 2.6%/y among black women. CONCLUSIONS-: Although these findings from 4 communities may not be directly generalizable to blacks and whites in the entire United States, we observed significant declines in MI incidence, primarily as a result of downward trends in rates between 1997 and 2008.

Original languageEnglish (US)
Pages (from-to)1848-1857
Number of pages10
JournalCirculation
Volume125
Issue number15
DOIs
StatePublished - Apr 17 2012

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Coronary Disease
Myocardial Infarction
Mortality
Incidence
Biomarkers
Troponin
Atherosclerosis
Survival
Enzymes

Keywords

  • epidemiology
  • mortality rates
  • myocardial infarction
  • surveillance
  • survival

ASJC Scopus subject areas

  • Physiology (medical)
  • Cardiology and Cardiovascular Medicine

Cite this

Twenty-two-year trends in incidence of myocardial infarction, coronary heart disease mortality, and case fatality in 4 US communities, 1987-2008. / Rosamond, Wayne D.; Chambless, Lloyd E.; Heiss, Gerardo; Mosley, Thomas H.; Coresh, Josef; Whitsel, Eric; Wagenknecht, Lynne; Ni, Hanyu; Folsom, Aaron R.

In: Circulation, Vol. 125, No. 15, 17.04.2012, p. 1848-1857.

Research output: Contribution to journalArticle

Rosamond, Wayne D. ; Chambless, Lloyd E. ; Heiss, Gerardo ; Mosley, Thomas H. ; Coresh, Josef ; Whitsel, Eric ; Wagenknecht, Lynne ; Ni, Hanyu ; Folsom, Aaron R. / Twenty-two-year trends in incidence of myocardial infarction, coronary heart disease mortality, and case fatality in 4 US communities, 1987-2008. In: Circulation. 2012 ; Vol. 125, No. 15. pp. 1848-1857.
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AU - Rosamond, Wayne D.

AU - Chambless, Lloyd E.

AU - Heiss, Gerardo

AU - Mosley, Thomas H.

AU - Coresh, Josef

AU - Whitsel, Eric

AU - Wagenknecht, Lynne

AU - Ni, Hanyu

AU - Folsom, Aaron R.

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N2 - 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 4 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 over time. During 1987-2008, a total of 30 985 fatal or nonfatal hospitalized acute MI events occurred. Rates of CHD death among persons without a history of MI fell an average 4.7%/y among men and 4.3%/y 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% among white men, 3.8% among white women, 3.4% among black women, and 1.5% 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 3.5%/y among white men, 3.6%/y among black men, 3.0%/y among white women, and 2.6%/y among black women. CONCLUSIONS-: Although these findings from 4 communities may not be directly generalizable to blacks and whites in the entire United States, we observed significant declines in MI incidence, primarily as a result of downward trends in rates between 1997 and 2008.

AB - 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 4 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 over time. During 1987-2008, a total of 30 985 fatal or nonfatal hospitalized acute MI events occurred. Rates of CHD death among persons without a history of MI fell an average 4.7%/y among men and 4.3%/y 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% among white men, 3.8% among white women, 3.4% among black women, and 1.5% 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 3.5%/y among white men, 3.6%/y among black men, 3.0%/y among white women, and 2.6%/y among black women. CONCLUSIONS-: Although these findings from 4 communities may not be directly generalizable to blacks and whites in the entire United States, we observed significant declines in MI incidence, primarily as a result of downward trends in rates between 1997 and 2008.

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KW - mortality rates

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KW - surveillance

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