title: Twenty-two-year trends in incidence of myocardial infarction, coronary heart disease mortality, and case fatality in 4 US communities, 1987-2008.
abstract: BACKGROUND
  Knowledge of trends in the incidence of and survival after myocardial infarction (MI) in a community setting is important to understanding trends in coronary heart disease (CHD) mortality rates.
  
  
  RESULTS
  We estimated race- and gender-specific trends in the incidence of hospitalized MI, case fatality, and 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 4 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%/y among men and 4.3%/y 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%/y among white men, 3.6%/y among black men, 3.0%/y among white women, and 2.6%/y among black women.
  
  
  CONCLUSIONS
  Although these findings from 4 communities may not be directly generalizable to blacks and whites in the entire United States, we observed significant declines in MI incidence, primarily as a result of downward trends in rates between 1997 and 2008.
authors.affiliation: Departments of Epidemiology, School of Medicine, University of North Carolina, Chapel Hill, USA. Wayne_Rosamond@unc.edu
authors.forename: Wayne D
authors.initials: WD
authors.lastname: Rosamond
authors.forename: Lloyd E
authors.initials: LE
authors.lastname: Chambless
authors.forename: Gerardo
authors.initials: G
authors.lastname: Heiss
authors.forename: Thomas H
authors.initials: TH
authors.lastname: Mosley
authors.forename: Josef
authors.initials: J
authors.lastname: Coresh
authors.forename: Eric
authors.initials: E
authors.lastname: Whitsel
authors.forename: Lynne
authors.initials: L
authors.lastname: Wagenknecht
authors.forename: Hanyu
authors.initials: H
authors.lastname: Ni
authors.forename: Aaron R
authors.initials: AR
authors.lastname: Folsom
mesh_terms: D000328:Adult; D000368:Aged; D003327:Coronary Disease / Q000401:mortality*; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology*; D013997:Time Factors