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

Shah, A. S.V. et al. (2021) Clinical burden, risk factor impact and outcomes following myocardial infarction and stroke: a 25-year individual patient level linkage study. Lancet Regional Health - Europe, 7, 100141. (doi: 10.1016/j.lanepe.2021.100141) (PMID:34405203) (PMCID:PMC8351196)

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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:Articles
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:Katikireddi, Professor Vittal and McAllister, Professor David and Newby, Professor David and Campbell, Dr Desmond and Lewsey, Professor Jim and Logue, Dr Jennifer
Authors: Shah, A. S.V., Lee, K. K., Pérez, J. A. R., Campbell, D., Astengo, F., Logue, J., Gallacher, P. J., Katikireddi, S. V., Bing, R., Alam, S. R., Anand, A., Sudlow, C., Fishbacher, C. M., Lewsey, J., Perel, P., Newby, D. E., Mills, N. L., and McAllister, D. A.
College/School:College of Medical Veterinary and Life Sciences > Institute of Cardiovascular and Medical Sciences
College of Medical Veterinary and Life Sciences > Institute of Health and Wellbeing > Health Economics and Health Technology Assessment
College of Medical Veterinary and Life Sciences > Institute of Health and Wellbeing > MRC/CSO SPHSU
College of Medical Veterinary and Life Sciences > Institute of Health and Wellbeing > Public Health
Journal Name:Lancet Regional Health - Europe
Publisher:Lancet Publishing Group
ISSN:2666-7762
ISSN (Online):2666-7762
Published Online:16 June 2021
Copyright Holders:Copyright © 2021 The Authors
First Published:First published in Lancet Regional Health - Europe 7: 100141
Publisher Policy:Reproduced under a Creative Commons License

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Project CodeAward NoProject NamePrincipal InvestigatorFunder's NameFunder RefLead Dept
173492Combining efficacy estimates from clinical trials with the natural history obtained from large routine healthcare databases to determine net overall treatment benefitsDavid McAllisterWellcome Trust (WELLCOTR)201492/Z/16/ZInstitute of Health & Wellbeing
172690Understanding the impacts of welfare policy on health: A novel data linkage studySrinivasa KatikireddiOffice of the Chief Scientific Adviser (CSO)SCAF/15/02HW - Public Health
Inequalities in healthMedical Research Council (MRC)MC_UU_00022/2HW - MRC/CSO Social and Public Health Sciences Unit
Chief Scientist Office (CSO)SPHSU17