Clinical burden, risk factor impact and outcomes following myocardial infarction and stroke:A 25-year individual patient level linkage study

Shah, A.S.V. and Lee, K.K. and Pérez, J.A.R. and Campbell, D. and Astengo, F. and Logue, J. and Gallacher, P.J. and Katikireddi, S.V. and Bing, R. and Alam, S.R. and Anand, A. and Sudlow, C. and Fischbacher, C.M. and Lewsey, J. and Perel, P. and Newby, D.E. and Mills, N.L. and McAllister, D.A. (2021) Clinical burden, risk factor impact and outcomes following myocardial infarction and stroke:A 25-year individual patient level linkage study. The Lancet Regional Health - Europe, 7.

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Abstract

Background: Understanding trends in the incidence and outcomes of myocardial infarction and stroke, and how these are influenced by changes in cardiovascular risk factors can inform health policy and healthcare provision. Methods: We identified all patients 30 years or older with myocardial infarction or stroke in Scotland. Risk factor levels were determined from national health surveys. Incidence, potential impact fractions and burden attributable to risk factor changes were calculated. Risk of subsequent fatal and non-fatal events (myocardial infarction, stroke, bleeding and heart failure hospitalization) were calculated with multi-state models. Findings: From 1990 to 2014, there were 372,873 (71±13 years) myocardial infarctions and 290,927 (74±13 years) ischemic or hemorrhagic strokes. Age-standardized incidence per 100,000 fell from 1,069 (95% confidence interval, 1,024-1,116) to 276 (263-290) for myocardial infarction and from 608 (581-636) to 188 (178-197) for ischemic stroke. Systolic blood pressure, smoking and cholesterol decreased, but body-mass index increased, and diabetes prevalence doubled. Changes in risk factors accounted for a 74% (57-91%) reduction in myocardial infarction and 68% (55-83%) reduction in ischemic stroke. Following myocardial infarction, the risk of death decreased (30% to 20%), but non-fatal events increased (20% to 24%) whereas the risk of both death (47% to 34%) and non-fatal events (22% to 17%) decreased following stroke. Interpretation: Over the last 25 years, substantial reductions in myocardial infarction and ischemic stroke incidence are attributable to major shifts in risk factor levels. Deaths following the index event decreased for both myocardial infarction and stroke, but rates remained substantially higher for stroke. Funding: British heart foundation.

Item Type:
Journal Article
Journal or Publication Title:
The Lancet Regional Health - Europe
Additional Information:
CH/09/002, RE/18/5/34216, RG/16/10/32375, SPHSU17, WT103782AIA Funding details: National Rosacea Society, NRS, SCAF/15/02 Funding details: Wellcome Trust, WT, 201492/Z/16/Z Funding details: Medical Research Council, MRC, MC_UU_00022/2 Funding details: British Heart Foundation, BHF, FS/19/17/34172 Funding details: Academy of Medical Sciences Funding text 1: Declaration of interest: JL has is on the Advisory Board and has received Research Consultancy fees from Novo Nordisk . This study was funded by the British Heart Foundation through an Intermediate Clinical Research Fellowship (FS/19/17/34172) and a Clinical Lecturer Starter Grant from the Academy of Medical Sciences. DAM is supported by a Wellcome Trust Intermediate Clinical Fellowship (201492/Z/16/Z). SVK is funded by a NRS Senior Clinical Fellowship (SCAF/15/02), the Medical Research Council (MC_UU_00022/2 and the Scottish Government Chief Scientist Office (SPHSU17). DC is funded by an unrestricted gift from Baillie Gifford. DEN is supported by the British Heart Foundation (CH/09/002, RG/16/10/32375, RE/18/5/34216) and Wellcome Trust (WT103782AIA). All other authors have no conflicts to declare. 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ID Code:
158653
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Deposited On:
01 Sep 2021 14:05
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Published
Last Modified:
06 Oct 2021 08:25