Trends in the Incidence of Myocardial Infarction and in Mortality Due to Coronary Heart Disease, 1987 to 1994

Wayne D. Rosamond, Lloyd E. Chambless, Aaron R. Folsom, Lawton S. Cooper, David E. Conwill, Limin Clegg, Chin-Hua Wang, Gerardo Heiss

Abstract

Background and Methods. To clarify the determinants of contemporary trends in mortality from coronary heart disease (CHD), we conducted surveillance of hospital admissions for myocardial infarction and of in-hospital and out-of-hospital deaths due to CHD among 35-to-74-year-old residents of four communities of varying size in the United States (a total of 352,481 persons in 1994). Between 1987 and 1994, we estimate that there were 11,869 hospitalizations for myocardial infarction (on the basis of 8572 hospitalizations sampled) and 3407 fatal coronary events (3023 sampled).

Results. The largest average annual decrease in mortality due to CHD occurred among white men (change in mortality, -4.7 percent; 95 percent confidence interval, -2.2 to -7.1 percent), followed by white women (-4.5 percent; 95 percent confidence interval, -0.7 to -8.2 percent), black women (-4.1 percent; 95 percent confidence interval, -10.3 to +2.5 percent), and black men (-2.5 percent; 95 percent confidence interval, -6.9 to +2.2 percent). Overall, in-hospital mortality from CHD fell by 5.1 percent per year, whereas out-of-hospital mortality declined by 3.6 percent per year. There was no evidence of a decline in the incidence of hospitalization for a first myocardial infarction among either men or women; in fact, such hospital admissions increased by 7.4 percent per year (95 percent confidence interval, 0.5 to 14.8 percent) among black women and 2.9 percent per year (95 percent confidence interval, -3.6 to +9.9 percent) among black men. Rates of recurrent myocardial infarction decreased, and survival after myocardial infarction improved.

Conclusions. From 1987 to 1994, we observed a stable or slightly increasing incidence of hospitalization for myocardial infarction. Nevertheless, there were significant annual decreases in mortality from CHD. The decline in mortality in the four communities we studied may be due largely to improvements in the treatment and secondary prevention of myocardial infarction. (N Engl J Med 1998;339:861-7.)

Source Information

From the Departments of Epidemiology (W.D.R., G.H.) and Biostatistics (L.E.C., L.C., C.-H.W.), School of Public Health, University of North Carolina, Chapel Hill; the Division of Epidemiology, School of Public Health, University of Minnesota, Minneapolis (A.R.F.); the National Heart, Lung, and Blood Institute, Bethesda, Md. (L.S.C.); and the Division of Epidemiology, Department of Preventive Medicine, University of Mississippi Medical Center, Jackson (D.E.C.). Address reprint requests to Dr. Rosamond at the Department of Epidemiology, University of North Carolina at Chapel Hill, CB 7400, McGavran-Greenberg Hall, Chapel Hill, NC 27599.

Appendix

|In addition to the authors, the following also participated in this study: University of North Carolina, Chapel Hill -- P. Johnson, M. Knowles, C. Paton; Wake Forest University, Winston-Salem, N.C. -- K. Burke, W. Cheeks, R. Cook, S. Cothern; University of Mississippi Medical Center, Jackson -- B. Warren, D. Washington, M. Watson, N. Wilson; University of Minnesota, Minneapolis -- G. Feitl, C. Hunkins, E. Justiniano, L. Kemmis; Johns Hopkins University, Baltimore -- J. Chabot, C. Christman, D. Costa, P. Crowley; University of Texas Medical School, Houston -- V. Stinson, P. Pfile, H. Pham, T. Trevino; Atherosclerosis Clinical Laboratory, Methodist Hospital, Houston -- W. Alexander, D. Harper, C. Rhodes, S. Soyal; Ultrasound Reading Center, Bowman Gray School of Medicine, Winston-Salem, N.C. -- A. Safrit, M. Wilder, L. Allred, C. Bell; Coordinating Center, University of North Carolina, Chapel Hill -- P. DeSaix, S. Goode, T. Goodwin, S. Hutton.