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[Epidemiology of coronary heart disease]
1Abteilung Innere Medizin II-Kardiologie Medizinische Universitätsklinik, Ulm.
Insights
Regional variations in acute myocardial infarction (AMI) incidence persist, unexplained by traditional risk factors. Despite improved treatments, high case fatality rates and future increases in ischemic heart disease (IHD) highlight the need for better understanding of medical care impacts.
Area of Science:
- Cardiology
- Public Health
- Epidemiology
Context:
- Acute myocardial infarction (AMI) incidence exhibits significant regional disparities, not fully explained by established risk factors.
- Ischemic heart disease (IHD) mortality trends vary globally, with decreases in Western Europe and increases in Eastern Europe.
- Despite advancements in prevention and treatment, the population-level impact of medical care on AMI prognosis remains unclear.
Purpose:
- To investigate the unexplained regional variations in AMI incidence.
- To analyze time trends in IHD mortality across different European regions.
- To assess the impact of medical care on short- and long-term AMI outcomes.
Summary:
- Regional differences in acute myocardial infarction (AMI) incidence are substantial and not fully accounted for by classical risk factors.
- The 28-day case fatality rate for AMI remains high (average 50%), despite therapeutic improvements.
- Mortality trends for ischemic heart disease (IHD) show divergence between Western and Eastern Europe.
- The population-level effect of medical interventions on AMI prognosis requires further elucidation.
- IHD incidence and prevalence are projected to rise due to demographic shifts, particularly an aging population.
Impact:
- Highlights the need for further research into the determinants of regional AMI variability.
- Underscores the persistent challenge of high AMI case fatality and the need for enhanced therapeutic strategies.
- Informs public health strategies by identifying regional trends in IHD mortality.
- Emphasizes the importance of understanding medical care's role in improving AMI patient outcomes.
- Provides a basis for future health policy planning to address the growing burden of IHD in aging populations.
Abstract:
The incidence of acute myocardial infarction (AMI) shows large regional differences. This variability cannot be completely explained by differences in classical risk factors. 28-day case fatality of AMI remains unacceptably high with 50% on the average, although therapeutic possibilities have improved considerably. Time trends in mortality from ischaemic heart disease (IHD) show a decrease in most Western European countries and an increase in Eastern Europe. On a population level, the impact of medical care on the short-term and long-term prognosis of AMI is not completely understood. Despite considerable progress in primary and secondary prevention, the incidence and prevalence of IHD will increase in the future due to aging of the population.