Changes in Risk Factors Associated with Reduced MI and Stroke Incidence in Scotland

Takeaway

• Over a period of 25 years, changes in major cardiovascular risk factors were associated with substantial reductions in myocardial infarction (MI) and ischaemic stroke (IS) incidence in Scotland.

Why this matters

• Findings have implications for public health policy and healthcare provision.

Study details

• The individual patient-level linkage study included Scottish patients (age, ≥30 years) with MI or IS between 1 January 1990 and 21 December 2014, followed-up until 31 December 2017.
• Funding: British Heart Foundation.

Key results

• Among 605,996 patients, 372,873 and 290,927 cases of index MI and IS, respectively, were recorded.
• MI and IS incidence per 100,000 declined from 1069 (95% CI, 1024-1116) and 608 (95% CI, 581-636) to 276 (95% CI, 263-290) and 188 (95% CI, 188 (95% CI, 178-197), respectively.
• Over 25 years, systolic blood pressure (SBP), smoking prevalence and cholesterol levels decreased but body mass index (BMI) and diabetes prevalence increased:

• SBP: 140 (95% CI, 139-140) to 129 (95% CI, 129-130) mmHg;
• smoking: 58% (95% CI, 54-63%) to 25% (95% CI, 24-26%);
• cholesterol: 6.4 (95% CI, 6.2-6.6) to 5.1 (95% CI, 5.0-5.3) mmol/L;
• BMI: 27.2 (95% CI, 27.0-27.4) to 28.1 (95% CI, 28.0-28.2) kg/m²; and
• diabetes: 4% (95% CI, 3-5%) to 9% (95% CI, 8-9%).

• Changes in risk factors was associated with a 74% and 68% reduction in MI and IS, respectively.
• Risk of death with no interceding event following MI and stroke decreased from 30% to 20% and from 47% to 34%, respectively.

Limitations

• Possible over-estimation of reduction in incidence of individual risk factors.
• Predominantly White population.
• Lag times between changes in risk factors and incident disease were not considered.
   

This clinical summary originally appeared on Univadis, part of the Medscape Professional Network.