Key result
Incorporating cardiovascular risk factor trends projected a decrease in incident myocardial infarctions by 2017 (males: -23.7%, females: -17.1%), offsetting expected increases from demographic changes.
Why the study?
Does considering trends in cardiovascular risk factor prevalences alter the predicted future incidence of myocardial infarction compared to predictions based on demographic changes alone?
Cohort (n=7,387)
Does considering trends in cardiovascular risk factor prevalences alter the predicted future incidence of myocardial infarction compared to predictions based on demographic changes alone?
Predicting future myocardial infarction incidence based solely on demographic changes overestimates future cases, as favorable trends in cardiovascular risk factor prevalences can offset the impact of an aging population.
Risk factor trends may offset demographic MI increases in projections; extends modeling but remains hypothesis-generating without prospective validation.
BACKGROUND: Previous predictions of population morbidity consider demographic changes only. To model future morbidity, however, changes in prevalences of risk factors should be considered. We calculated the number of incident cases of first myocardial infarction (MI) in Mecklenburg-Western Pomerania in 2017 considering the effects of demographic changes and trends in the prevalences of major risk factors simultaneously. METHODS: Data basis of the analysis were two population-based cohorts of the German Study of Health in Pomerania (SHIP-baseline [1997-2001] and the 5-year follow-up and SHIP-Trend-baseline [2008-2011] respectively). SHIP-baseline data were used to calculate the initial coefficients for major risk factors for MI with a Poisson regression model. The dependent variable was the number of incident cases of MI between SHIP-baseline and SHIP-5-year follow-up. Explanatory variables were sex, age, a validated diagnosis of hypertension and/or diabetes, smoking, waist circumference (WC), increased blood levels of triglycerides (TG) and low-density-lipoprotein cholesterol (LDL), and low blood levels of high-density-lipoprotein cholesterol (HDL). Applying the coefficients determined for SHIP baseline to risk factor prevalences, derived from the new cohort SHIP-Trend together with population forecast data, we calculated the projected number of incident cases of MI in 2017. RESULTS: Except for WC and smoking in females, prevalences of risk factors in SHIP-Trend-baseline were lower compared to SHIP-baseline. Based on demographic changes only, the calculated incidence of MI for 2017 compared to the reference year 2006 yields an increase of MI (males: +11.5%, females: +8.0%). However, a decrease of MI (males: -23.7%, females: -17.1%) is shown considering the changes in the prevalences of risk factors in the projection. CONCLUSIONS: The predicted number of incident cases of MI shows large differences between models with and without considering changes in the prevalences of major risk factors. Hence, the prediction of incident MI should preferably not only be based on demographic changes.
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Hoffmann et al. (2015) conducted a cohort in Myocardial Infarction (n=7,387). Trends in cardiovascular risk factor prevalences vs. Demographic changes only was evaluated on Projected number of incident cases of first myocardial infarction in 2017. Incorporating cardiovascular risk factor trends projected a decrease in incident myocardial infarctions by 2017 (males: -23.7%, females: -17.1%), offsetting expected increases from demographic changes.
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