February 28, 2020
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MI incidence declining more slowly in women

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Between 2000 and 2014, adults in the Kaiser Permanente Southern California database experienced yearly decline in incidence of acute MI. However, in recent years, this rate of decline has slowed in women while remaining consistent in men.

According to research published in Circulation, the age/sex standardized incidence of acute MI declined from 322.4 per 100,000 person-years in 2000 (95% CI, 311-333.9) to 174.6 per 100,000 person-years in 2014 (95% CI, 168.2-181), representing an overall decline of 46.6%.

Nevertheless, for women, the average annual percent change for acute MI changed from –4.6% between 2000 and 2009 (95% CI, –4.1 to –5.2) to –2.3% (95% CI, –1.2 to –3.4) between 2010 and 2014, whereas in men, researchers observed a more stable decline of –4.7% during the study period (95% CI, –4.4 to –4.9).

“The study points to the need for continued improvement in the awareness, prevention, recognition and treatment of risk factors for heart disease in women,” Kristi Reynolds, PhD, MPH, director of epidemiologic research in the department of research and evaluation at Kaiser Permanente Southern California, said in a press release. “It also shows that more research needs to be done to understand the disparities between men and women.”

Patterns in MI incidence

In other findings, researchers noted that among women, STEMI declined –10.2% from 2000 to 2009 (95% CI, –9.3 to –11.1), but the rate of decline slowed to –5.2% between 2010 and 2014 (95% CI, –3.1 to –7.3). In men, the decline remained steady at –8% during the entire period (95% CI, –7.6 to –8.4).

Additionally, average annual decline for non-STEMI hospitalization was less than that of STEMI among both men (–2.8%; 95% CI, –2.5 to –3.2) and women (–1.9%; 95% CI, –1.5 to –2.3).

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The slowing decline of MI in women between 2000 and 2014.

“We are very proud the rate of heart attacks continues to decline among men and women within Kaiser Permanente Southern California,” Ronald Scott, MD, family physician at the Kaiser Permanente West Los Angeles Medical Center and the cardiovascular co-lead for the Southern California Permanente Medical Group, said in the release. “And we want to continue the trend of lowering the rate of heart attacks among both men and women by prescribing statins as a preventive medication and continuing to recommend lifestyle changes such as improved diet and exercise.”

Researchers identified all patients aged at least 35 years with acute MI hospitalized at Kaiser Permanente Southern California, between 2000 and 2014. Enrolled patients had no history of acute MI between 1996 and 2000. Readmissions within 1 week of discharge with the same principal discharge diagnosis code were considered the same event, according to the study.

Integrated health care system

“Advantages of an integrated health care delivery system, such as the ability to coordinate care and conduct care-improvement initiatives that target prevention and improve outcomes, may ex-plain the decline of acute MI rates among Kaiser Permanente Southern California members at all ages,” the researchers wrote. “However, further research may be warranted to examine factors driving STEMI and non-STEMI rates among young women.” – by Scott Buzby

Disclosures: Reynolds and Scott report no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.