title: Trends in Modifiable Risk Factors Are Associated With Declining Incidence of Hospitalized and Nonhospitalized Acute Coronary Heart Disease in a Population.
abstract: BACKGROUND
  Few studies have used individual person data to study whether contemporary trends in the incidence of coronary heart disease are associated with changes in modifiable coronary risk factors.
  
  
  RESULTS
  We identified 29 582 healthy men and women ≥25 years of age who participated in 3 population surveys conducted between 1994 and 2008 in Tromsø, Norway. Age- and sex-adjusted incidence rates were calculated for coronary heart disease overall, out-of-hospital sudden death, and hospitalized ST-segment-elevation and non-ST-segment-elevation myocardial infarction. We measured coronary risk factors at each survey and estimated the relationship between changes in risk factors and changes in incidence trends. A total of 1845 participants had an incident acute coronary heart disease event during 375 064 person-years of follow-up from 1994 to 2010. The age- and sex-adjusted incidence of total coronary heart disease decreased by 3% (95% confidence interval, 2.0-4.0; P<0.001) each year. This decline was driven by decreases in out-of-hospital sudden death and hospitalized ST-segment-elevation myocardial infarction. Changes in coronary risk factors accounted for 66% (95% confidence interval, 48-97; P<0.001) of the decline in total coronary heart disease. Favorable changes in cholesterol contributed 32% to the decline, whereas blood pressure, smoking, and physical activity each contributed 14%, 13%, and 9%, respectively.
  
  
  CONCLUSIONS
  We observed a substantial decline in the incidence of coronary heart disease that was driven by reductions in out-of-hospital sudden death and hospitalized ST-segment-elevation myocardial infarction. Changes in modifiable coronary risk factors accounted for 66% of the decline in coronary heart disease events.
authors.affiliation: From Department of Heart Disease, Division of Cardiothoracic and Respiratory Medicine (J.M., K.R.) and Department of Neurology, Division of Neurosciences and Orthopedics (E.B.M.), University Hospital of North Norway, Tromsø; Departments of Community Medicine (J.M., T.W., M.-L.L., I.N., L.A.H., K.H.B.) and Clinical Medicine (E.B.M., K.R.), UiT, Arctic University of Norway, Tromsø; Department of Biostatistics, Institute of Basic Medical Science, University of Oslo, Norway (D.S.T.); Clinic for Heart Disease, St. Olavs University Hospital, Trondheim, Norway (K.H.B.); and Department of Cancer Research and Molecular Medicine, Norwegian University of Science and Technology, Trondheim (K.H.B.). jan.mannsverk@unn.no.
authors.forename: Jan
authors.initials: J
authors.lastname: Mannsverk
authors.affiliation: From Department of Heart Disease, Division of Cardiothoracic and Respiratory Medicine (J.M., K.R.) and Department of Neurology, Division of Neurosciences and Orthopedics (E.B.M.), University Hospital of North Norway, Tromsø; Departments of Community Medicine (J.M., T.W., M.-L.L., I.N., L.A.H., K.H.B.) and Clinical Medicine (E.B.M., K.R.), UiT, Arctic University of Norway, Tromsø; Department of Biostatistics, Institute of Basic Medical Science, University of Oslo, Norway (D.S.T.); Clinic for Heart Disease, St. Olavs University Hospital, Trondheim, Norway (K.H.B.); and Department of Cancer Research and Molecular Medicine, Norwegian University of Science and Technology, Trondheim (K.H.B.).
authors.forename: Tom
authors.initials: T
authors.lastname: Wilsgaard
authors.affiliation: From Department of Heart Disease, Division of Cardiothoracic and Respiratory Medicine (J.M., K.R.) and Department of Neurology, Division of Neurosciences and Orthopedics (E.B.M.), University Hospital of North Norway, Tromsø; Departments of Community Medicine (J.M., T.W., M.-L.L., I.N., L.A.H., K.H.B.) and Clinical Medicine (E.B.M., K.R.), UiT, Arctic University of Norway, Tromsø; Department of Biostatistics, Institute of Basic Medical Science, University of Oslo, Norway (D.S.T.); Clinic for Heart Disease, St. Olavs University Hospital, Trondheim, Norway (K.H.B.); and Department of Cancer Research and Molecular Medicine, Norwegian University of Science and Technology, Trondheim (K.H.B.).
authors.forename: Ellisiv B
authors.initials: EB
authors.lastname: Mathiesen
authors.affiliation: From Department of Heart Disease, Division of Cardiothoracic and Respiratory Medicine (J.M., K.R.) and Department of Neurology, Division of Neurosciences and Orthopedics (E.B.M.), University Hospital of North Norway, Tromsø; Departments of Community Medicine (J.M., T.W., M.-L.L., I.N., L.A.H., K.H.B.) and Clinical Medicine (E.B.M., K.R.), UiT, Arctic University of Norway, Tromsø; Department of Biostatistics, Institute of Basic Medical Science, University of Oslo, Norway (D.S.T.); Clinic for Heart Disease, St. Olavs University Hospital, Trondheim, Norway (K.H.B.); and Department of Cancer Research and Molecular Medicine, Norwegian University of Science and Technology, Trondheim (K.H.B.).
authors.forename: Maja-Lisa
authors.initials: ML
authors.lastname: Løchen
authors.affiliation: From Department of Heart Disease, Division of Cardiothoracic and Respiratory Medicine (J.M., K.R.) and Department of Neurology, Division of Neurosciences and Orthopedics (E.B.M.), University Hospital of North Norway, Tromsø; Departments of Community Medicine (J.M., T.W., M.-L.L., I.N., L.A.H., K.H.B.) and Clinical Medicine (E.B.M., K.R.), UiT, Arctic University of Norway, Tromsø; Department of Biostatistics, Institute of Basic Medical Science, University of Oslo, Norway (D.S.T.); Clinic for Heart Disease, St. Olavs University Hospital, Trondheim, Norway (K.H.B.); and Department of Cancer Research and Molecular Medicine, Norwegian University of Science and Technology, Trondheim (K.H.B.).
authors.forename: Knut
authors.initials: K
authors.lastname: Rasmussen
authors.affiliation: From Department of Heart Disease, Division of Cardiothoracic and Respiratory Medicine (J.M., K.R.) and Department of Neurology, Division of Neurosciences and Orthopedics (E.B.M.), University Hospital of North Norway, Tromsø; Departments of Community Medicine (J.M., T.W., M.-L.L., I.N., L.A.H., K.H.B.) and Clinical Medicine (E.B.M., K.R.), UiT, Arctic University of Norway, Tromsø; Department of Biostatistics, Institute of Basic Medical Science, University of Oslo, Norway (D.S.T.); Clinic for Heart Disease, St. Olavs University Hospital, Trondheim, Norway (K.H.B.); and Department of Cancer Research and Molecular Medicine, Norwegian University of Science and Technology, Trondheim (K.H.B.).
authors.forename: Dag S
authors.initials: DS
authors.lastname: Thelle
authors.affiliation: From Department of Heart Disease, Division of Cardiothoracic and Respiratory Medicine (J.M., K.R.) and Department of Neurology, Division of Neurosciences and Orthopedics (E.B.M.), University Hospital of North Norway, Tromsø; Departments of Community Medicine (J.M., T.W., M.-L.L., I.N., L.A.H., K.H.B.) and Clinical Medicine (E.B.M., K.R.), UiT, Arctic University of Norway, Tromsø; Department of Biostatistics, Institute of Basic Medical Science, University of Oslo, Norway (D.S.T.); Clinic for Heart Disease, St. Olavs University Hospital, Trondheim, Norway (K.H.B.); and Department of Cancer Research and Molecular Medicine, Norwegian University of Science and Technology, Trondheim (K.H.B.).
authors.forename: Inger
authors.initials: I
authors.lastname: Njølstad
authors.affiliation: From Department of Heart Disease, Division of Cardiothoracic and Respiratory Medicine (J.M., K.R.) and Department of Neurology, Division of Neurosciences and Orthopedics (E.B.M.), University Hospital of North Norway, Tromsø; Departments of Community Medicine (J.M., T.W., M.-L.L., I.N., L.A.H., K.H.B.) and Clinical Medicine (E.B.M., K.R.), UiT, Arctic University of Norway, Tromsø; Department of Biostatistics, Institute of Basic Medical Science, University of Oslo, Norway (D.S.T.); Clinic for Heart Disease, St. Olavs University Hospital, Trondheim, Norway (K.H.B.); and Department of Cancer Research and Molecular Medicine, Norwegian University of Science and Technology, Trondheim (K.H.B.).
authors.forename: Laila Arnesdatter
authors.initials: LA
authors.lastname: Hopstock
authors.affiliation: From Department of Heart Disease, Division of Cardiothoracic and Respiratory Medicine (J.M., K.R.) and Department of Neurology, Division of Neurosciences and Orthopedics (E.B.M.), University Hospital of North Norway, Tromsø; Departments of Community Medicine (J.M., T.W., M.-L.L., I.N., L.A.H., K.H.B.) and Clinical Medicine (E.B.M., K.R.), UiT, Arctic University of Norway, Tromsø; Department of Biostatistics, Institute of Basic Medical Science, University of Oslo, Norway (D.S.T.); Clinic for Heart Disease, St. Olavs University Hospital, Trondheim, Norway (K.H.B.); and Department of Cancer Research and Molecular Medicine, Norwegian University of Science and Technology, Trondheim (K.H.B.).
authors.forename: Kaare Harald
authors.initials: KH
authors.lastname: Bønaa
mesh_terms: D054058:Acute Coronary Syndrome / Q000175:diagnosis* / Q000401:mortality* / Q000628:therapy; D000328:Adult; D005260:Female; D006760:Hospitalization / Q000639:trends; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009026:Mortality / Q000639:trends; D009664:Norway / Q000453:epidemiology; D058687:Out-of-Hospital Cardiac Arrest / Q000175:diagnosis / Q000401:mortality / Q000628:therapy; D011159:Population Surveillance / Q000379:methods; D011446:Prospective Studies; D012307:Risk Factors
keywords: coronary disease; epidemiology; incidence; mortality; myocardial infarction; risk factors