January 26th, 2012

Big Drop in MI Incidence and Fatality in England

Since 2002, the incidence of acute MI in England has dropped by one-half and the case fatality rate by one-third, according to a new study published in BMJ. The overall decline in deaths from MI is about equally due to improvements in the prevention of MI and the treatment of MI.

Kate Smolina and colleagues analyzed data from 861,134 acute MIs in England from 2002 through 2010. Over the course of the study period, the MI event rate declined:

  • in men by 33%, from 230 to 154 per 100,000, for an average annual decline of 4.8%
  • in women by 31%, from 95.4 to 66.0 per 100,000, for an average annual decline of 4.5%

Similarly, the case fatality rate also declined:

  • in men by 24%, from 42.0% to 32.1%, for an average annual decline of 3.6%
  • in women by 29%, from 42.2% to 29.9%, for an average annual decline of 4.2%

The authors report that for middle-aged people, the decline in event rate played a bigger role in the changes, but for younger and older people, the case fatality played a bigger role.

In an accompanying editorial, Hugh Tunstall-Pedoe writes that the progress made in England and other western countries has not been replicated elsewhere:

As the world population ages and becomes more industrialised and urbanised, the decline in coronary mortality is predominantly in rich nations, while rates increase in dozens of others. Can these countries learn from us, or must they repeat our mistakes?

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