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Myocardial Infarction Without Standard Modifiable Risk Factors From 2025-2040: Forecast Analysis of Multinational,
Grace Cao1, Nicholas Weight2, Silingga Metta Jauhari3
1Yong Loo Lin School of Medicine, National University Singapore, Singapore.
Background:
Standard modifiable risk factors (SMuRFs) are associated with increased risk of acute myocardial infarction (AMI). Patients with AMI in the absence of standard modifiable risk factors (SMuRF-less) have demonstrated excess mortality.
Objectives:
The study aims to forecast trends in prevalence and case fatality of SMuRF-less AMI in Singapore and United Kingdom.
Methods:
Data from the Singapore Myocardial Infarction Registry and the UK Myocardial Ischemia National Audit Project were used to construct Poisson regression models to predict the prevalence and case fatality rate of SMuRF-less AMI from 2025 to 2040.
Results:
From 2025 to 2040, SMuRF-less AMI cases are expected to contribute to larger proportions of total AMI cases in Singapore (5.8% [95% CI: 5.2%-6.4%] to 8.5% [95% CI: 6.2%-10.8%]) and United Kingdom (13.8% [95% CI: 13.0%-14.6%] to 16.9% [95% CI: 15.1%-18.7%]). The proportion of SMuRF-less AMI mortality of the total AMI mortality is set to decrease in the United Kingdom (11.3% [95% CI: 10.5%-12.1%] to 9.5% [95% CI: 7.7%-11.4%]), but increase in Singapore (6.3% [95% CI: 5.7%-6.9%] to 13.3% [95% CI: 10.9%-15.6%]). Men continue to bear the majority of SMuRF-less AMI prevalence, with the most rapid rise in young adults in Singapore (8.1%; 95% CI: 7.5%-8.7%) and middle-aged adults in the United Kingdom (2.3%; 95% CI: 1.5%-3.1%). The increase in SMuRF-less AMI prevalence is set to be more rapid in the overweight/obesity population (3.9%; 95% CI: 3.3%-4.5%).
Conclusions:
By 2040, SMuRF-less AMI will expand to a larger proportion of the AMI census in Western and Eastern populations. SMuRF-less AMI vulnerability will shift toward a younger, male-dominant demographic, with overweight/obesity as a dominant risk factor.
Insights
Acute myocardial infarction (AMI) without standard modifiable risk factors (SMuRF-less AMI) is projected to increase. By 2040, SMuRF-less AMI will affect younger, male populations, with overweight/obesity as a key risk factor.
Area of Science:
- Cardiovascular epidemiology
- Public health forecasting
- Myocardial infarction research
Background:
- Standard modifiable risk factors (SMuRFs) are linked to higher acute myocardial infarction (AMI) risk.
- Patients experiencing AMI without SMuRFs (SMuRF-less AMI) exhibit increased mortality rates.
Purpose of the Study:
- To forecast the prevalence and case fatality trends of SMuRF-less AMI in Singapore and the United Kingdom.
- To project these trends from 2025 to 2040.
Main Methods:
- Utilized data from the Singapore Myocardial Infarction Registry and the UK Myocardial Ischemia National Audit Project.
- Employed Poisson regression models to predict SMuRF-less AMI prevalence and case fatality rates.
- Forecasting period spans from 2025 to 2040.
Main Results:
- SMuRF-less AMI is expected to constitute a larger share of total AMI cases in Singapore (rising to 8.5%) and the UK (rising to 16.9%) by 2040.
- SMuRF-less AMI mortality's proportion of total AMI mortality will decrease in the UK but increase in Singapore (to 13.3%).
- Prevalence increases are most rapid in young adults in Singapore and middle-aged adults in the UK, with overweight/obesity being a significant factor.
Conclusions:
- SMuRF-less AMI is projected to represent a greater proportion of the overall AMI burden in both Western and Eastern populations by 2040.
- Vulnerability to SMuRF-less AMI is shifting towards a younger, male demographic.
- Overweight and obesity are emerging as dominant risk factors for SMuRF-less AMI.
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