Decreasing mortality from acute myocardial infarction: effect of incidenceand prognosis

Coronary heart disease (CHD) mortality rates have declined for the past 25 years in most western countries. During the 1970s and early 1980s, a declin e in incidence was the main factor in the decline in mortality, but more re cently, improvements in treatment and prognosis have played a larger role. Most of I:he change is a result of improvements in the treatment of risk fa ctors among patients with chronic CHD, while the treatment of acute myocard ial infarction has contributed a smaller part. CHD mortality has consistent ly decreased more than incidence, which may have led to an increased preval ence of CHD. Simultaneously, the treatment practice patterns and possibly a lso clinical presentation of CHD has changed so that hospitalizations as a result of CHD diagnoses other than myocardial infarction have increased, wh ile definite myocardial infarctions have decreased. Furthermore, the stabil izing rates of incident myocardial infarction combined with the aging popul ation tend to increase the numbers of CHD patients. Therefore, the total bu rden of CHD to the community has decreased less than one would expect on th e basis of age-standardized mortality rates. There is a need to re-emphasiz e primary prevention, since heavy reliance on expensive treatments for the post-war baby-boom generation presents a major concern for public health re sources. J Cardiovasc Risk 6:69-75 (C) 1999 Lippincott Williams & Wilkins.