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. 2021 Aug:7:100141.
doi: 10.1016/j.lanepe.2021.100141.

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

Anoop S V Shah  1   2 , Kuan Ken Lee  3 , Jesús Alberto Rodríguez Pérez  4 , Desmond Campbell  4 , Federica Astengo  3 , Jennifer Logue  5 , Peter James Gallacher  3 , Srinivasa Vittal Katikireddi  4 , Rong Bing  3 , Shirjel R Alam  1 , Atul Anand  3 , Catherine Sudlow  6 , Colin M Fischbacher  7 , Jim Lewsey  4 , Pablo Perel  1 , David E Newby  3 , Nicholas L Mills  3   6 , David A McAllister  4
Affiliations

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

Anoop S V Shah et al. Lancet Reg Health Eur. 2021 Aug.

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.

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Figures

Fig. 1.
Fig. 1.
Age standardized incidence rate per 100,000 for myocardial infarction, ischemic stroke and hemorrhagic stroke.
Fig. 2a.
Fig. 2a.
Stack barplot showing potential impact fraction for myocardial infarction and ischemic stroke by risk factor change from 1990 to 2014.
Fig. 2b.
Fig. 2b.
Stack plot showing absolute number of index myocardial infarction and ischemic stroke events delayed / prevented or caused by change in risk factor level.
Fig. 3.
Fig. 3.
Population risks from multistate models – unscaled sunburst plots showing stratum standardized risks for the population for fatal and non-fatal sequalae following index non-fatal myocardial infarction (A) and stroke (B). Note: A web application has been created (https://ihwph-hehta.shinyapps.io/614967/) to illustrate the predicted risks for up-to three levels for fatal or non-fatal subsequent events and four levels for subsequent fatal events. The web application also provides conditional probabilities of risks stratified by age, sex, deprivation, presence or absence of comorbidity and cohort period. An adjunct explanatory document has also been submitted to summarize how to use the web-application. On publication, the web application will be updated with the explanation.
See this image and copyright information in PMC

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