Key result
Over a 26-year period, the age-adjusted incidence of premature myocardial infarction declined by 39% in men (RR 0.61) and 61% in women (RR 0.39), while post-MI mortality declined only in women.
Why the study?
Trends in incident premature myocardial infarction and the prevalence of cardiac risk factors in a population-based cohort needed evaluation.
Cohort (n=850)
No
Effect estimate: RR 0.61 (men) and RR 0.39 (women) (95% CI 0.46 to 0.81 (men), 0.27 to 0.57 (women))
p-value: p=<0.001
Although the incidence of premature myocardial infarction declined over a 26-year period, the cardiovascular risk factor profile worsened, particularly in men, and post-MI mortality declined only in women.
Declining premature MI incidence amid worsening risk factors supports intensified primary prevention in young adults; leaves open sex-specific recurrence strategies.
OBJECTIVE: To evaluate the trends in incident premature myocardial infarction (MI) and prevalence of cardiac risk factors in a population-based cohort. METHODS: We studied a population-based cohort of incident premature MIs among residents (MI in men aged 18-55 years and women aged 18-65 years) in Olmsted County, Minnesota, during a 26-year period from January 1, 1987 through December 31, 2012. Recurrent MI and death after incident premature MI were enumerated through September 30, 2018. RESULTS: Of 3276 MI cases, 850 were premature events (37.9% [322/850] women). Age-adjusted premature MI incidence rates (2012 vs 1987) declined by 39% in men (rate ratio, 0.61; 95% CI, 0.46 to 0.81]) and 61% in women (rate ratio, 0.39; 95% CI, 0.27 to 0.57). Among men with premature MI, the prevalence of hypertension, diabetes, and hyperlipidemia increased over time, whereas in women, only the prevalence of hyperlipidemia increased. During a mean follow-up of 13.3 years, there was no temporal decline in recurrent MI in men and women. Women showed 66% decreased risk for mortality (hazard ratio, 0.34; 95% CI, 0.17 to 0.68) over time, whereas men showed no change. CONCLUSION: The incidence of premature MI declined over a 26-year period for both men and women. The risk factor profile of persons presenting with MI worsened over time, especially in men. Death following incident MI declined only in women. These results underscore the importance of primary prevention in young adults and of sex-specific approaches.
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Dugani et al. (2021) conducted a cohort in Premature Myocardial Infarction (n=850). Calendar year (2012 vs 1987) vs. 1987 was evaluated on Age-adjusted premature MI incidence rates (RR 0.61 (men) and RR 0.39 (women), 95% CI 0.46 to 0.81 (men), 0.27 to 0.57 (women), p=<0.001). Over a 26-year period, the age-adjusted incidence of premature myocardial infarction declined by 39% in men (RR 0.61) and 61% in women (RR 0.39), while post-MI mortality declined only in women.
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