Twenty-Two–Year Trends in Incidence of Myocardial Infarction, Coronary Heart Disease Mortality, and Case Fatality in 4 US Communities, 1987–2008

Study Questions:

What have been the long-term trends in the incidence of and survival after myocardial infarction (MI) in the community setting?


The authors estimated race- and gender-specific trends in the incidence of hospitalized MI, case fatality, and coronary heart disease (CHD) mortality from community-wide surveillance and validation of hospital discharges, and of in- and out-of-hospital deaths among 35- to 74-year-old residents of four communities in the Atherosclerosis Risk in Communities (ARIC) Study. Biomarker adjustment accounted for change from reliance on cardiac enzymes to widespread use of troponin measurements over time.


During 1987–2008, a total of 30,985 fatal or nonfatal hospitalized acute MI events occurred. Rates of CHD death among persons without a history of MI fell an average 4.7%/year among men and 4.3%/year among women. Rates of both in- and out-of-hospital CHD death declined significantly throughout the period. Age- and biomarker-adjusted average annual rate of incident MI decreased 4.3% among white men, 3.8% among white women, 3.4% among black women, and 1.5% among black men. Declines in CHD mortality and MI incidence were greater in the second decade (1997–2008). Failure to account for biomarker shift would have masked declines in incidence, particularly among blacks. Age-adjusted 28-day case fatality after hospitalized MI declined 3.5%/year among white men, 3.6%/year among black men, 3.0%/year among white women, and 2.6%/year among black women.


Although these findings from four communities may not be directly generalizable to blacks and whites in the entire United States, the authors observed significant declines in MI incidence, primarily as a result of downward trends in rates between 1997 and 2008.


The annual rate of age-adjusted decline in CHD deaths is very impressive, and while likely due to improved care, there is also a decline in incident MIs, particularly ST-segment elevation MIs. Importantly, the percent declines during the most recent time period (1997–2008) were approximately twice those of the previous decade and were most dramatic among blacks.

Keywords: Myocardial Infarction, United States

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