Atte Kallström

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.

Abstract Objective Acute coronary syndrome (ACS) incidence and case fatality (CF) have declined in the past decades, but some studies have suggested a potential stagnation in this decline. We examined how the ACS burden has evolved among persons aged 35-74 in Finland from 1996 to 2021. Methods We used Finnish country-wide Hospital Discharge- and Causes of Death-Registers covering first non-fatal and fatal ACS events, totaling 69 906 442 person-years at risk. We analyzed incidence, mortality, and 28-day CF, and their trends using negative binomial, Poisson, segmented, and logistic regression adjusting for age and sex. Results Altogether, the analysis consisted of 186 489 non-fatal and 72 907 fatal ACS events. ACS incidence declined in men (annual percentage change (APC) −2.0% [95% CI −2.2 to −1.8]) and in older women (APC of 55-64 year old −1.5% [−1.7 to −1.2] and 65-74 year old −3.3% [−3.4 to −3.2]), but the incidence decline slowed down over the last decade. In younger women aged 35-54, incidence was unchanged during the study period. ACS mortality and CF declined (APC of the mortality in men - 4.4% [−4.6 to −4.2] and in women −5.0% [−5.2 to −4.7]. APC of CF in men −2.7% [−2.8 to −2.6] and in women −3.3% [−3.6 to −3.1]). Conclusions ACS mortality declined in all groups, but the decline in ACS incidence slowed down and even halted in women. In women aged 35-54, the incidence was unchanged during the study period. These results emphasize the need of intensified cardiovascular prevention, particularly in women. Key messages What is already known on this topic During the last decades coronary artery disease treatment and prevention have improved worldwide which has led to a decline in ACS mortality and case fatality. However, recent studies from several countries suggest, that incidence decline has stagnated or even turned to increase, especially in younger age cohorts. What this study adds This study showed that incidence has ceased its decline in women aged 35-54 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 alarming results of this study underline the importance of intensifying prevention, focusing especially on young and middle-aged women .