Cardiovascular (CV) patients are becoming older with a greater number of CV risk factors (CVRFs). The Framingham risk score (FRS) includes the major CVRFs and is used for CV risk stratification. We investigated temporal trends in burden of CVRFs among patients with acute myocardial infarction (AMI) throughout a decade. Patients with AMI hospitalized through 2002 to 2012 were studied. The baseline characteristics included age, sex, ethnicity, type of AMI (ST-segment elevation [STEMI] vs non-STEMI [NSTEMI]), coronary artery disease (CAD), diabetes mellitus (DM), dyslipidemia, hypertension, obesity, smoking, and blood lipid profile. The FRS was calculated for each patient. A total of 14 698 AMI admissions were included (age 66.9 ± 13.6 years, 68% males, 47.6% STEMI). Half of admitted cases had ≥4 CVRFs. The mean FRS was 17.1 ± 4.1. Throughout the study period, patients with AMI became older with increased burden of CVRFs. The mean FRS increased from 16.8 ± 4.0 (2002) to 17.3 ± 4.1 (2012; P < .001). Multivariate analysis demonstrated a significant increase in FRS among patients with NSTEMI and significant decrease for patients with STEMI.
Conclusions:
The last decade, patients with AMI became older with increased burden of CVRFs. Framingham risk score increased among patients with NSTEMI and decreased in patients with STEMI. These trends impact on risk stratification and secondary prevention programs.
KrumholzHMNormandSLWangY. Trends in hospitalizations and outcomes for acute cardiovascular disease and stroke, 1999-2011. Circulation. 2014;130(12):966–75.
2.
YehRWSidneySChandraMSorelMSelbyJVGoAS. Population trends in the incidence and outcomes of acute myocardial infarction. N Engl J Med. 2010;362(23):2155–65.
3.
PlakhtYGilutzHShiyovichA. Temporal trends in acute myocardial infarction: What about survival of hospital survivors? Disparities between STEMI & NSTEMI remain. Soroka acute myocardial infarction II (SAMI-II) project. Int J Cardiol. 2016;203:1073–81.
4.
PlakhtYGilutzHShiyovichA. Ethnical disparities in temporal trends of acute myocardial infarction (AMI) throughout a decade in Israel. Soroka acute myocardial infarction (SAMI-II) project. Int J Cardiol. 2016;214:469–76.
5.
PlakhtYShiyovichA. Less is more: the dynamic epidemiology of cardiovascular diseases. Pol Arch Med Wewn. 2016;126(11):839–41.
6.
GuptaAWangYSpertusJA. Trends in acute myocardial infarction in young patients and differences by sex and race, 2001 to 2010. J Am Coll Cardiol. 2014;64(4):337–45.
7.
PetersonEDShahBRParsonsL. Trends in quality of care for patients with acute myocardial infarction in the National Registry of Myocardial Infarction from 1990 to 2006. Am Heart J. 2008;156(6):1045–55.
8.
HansenKWHvelplundAAbildstromSZ. Prognosis and treatment in patients admitted with acute myocardial infarction on weekends and weekdays from 1997 to 2009. Int J Cardiol. 2013;168(2):1167–73.
9.
InsamCPaccaudFMarques-VidalP. Trends in hospital discharges, management and in-hospital mortality from acute myocardial infarction in Switzerland between 1998 and 2008. BMC Public Health. 2013;13:270.
10.
KhotUNKhotMBBajzerCT. Prevalence of conventional risk factors in patients with coronary heart disease. JAMA. 2003;290(7):898–904.
11.
RidkerPMBuringJERifaiNCookNR. Development and validation of improved algorithms for the assessment of global cardiovascular risk in women: the Reynolds Risk Score. JAMA. 2007;297(6):611–19.
12.
D’AgostinoRBSrGrundySSullivanLMWilsonP; CHD Risk Prediction Group. Validation of the Framingham coronary heart disease prediction scores: results of a multiple ethnic groups investigation. JAMA. 2001;286(2):180–87.
13.
LiuJHongYD’AgostinoRBSr. Predictive value for the Chinese population of the Framingham CHD risk assessment tool compared with the Chinese Multi-Provincial Cohort Study. JAMA. 2004;291(21):2591–99.
14.
MarrugatJD’AgostinoRSullivanL. An adaptation of the Framingham coronary heart disease risk function to European Mediterranean areas. J Epidemiol Community Health. 2003;57(8):634–38.
15.
GunaydinZYKaragozABektasO. Comparison of the Framingham risk and SCORE models in predicting the presence and severity of coronary artery disease considering SYNTAX score. Anatol J Cardiol. 2016;16(6):412–18.
16.
SaraJDLennonRJGulatiR. Utility of the Framingham Risk Score in predicting secondary events in patients following percutaneous coronary intervention: A time-trend analysis. Am Heart J. 2016;172:115–128.
17.
PlakhtYGilutzHShiyovichA. Decreased admission serum albumin level is an independent predictor of long-term mortality in hospital survivors of acute myocardial infarction. Soroka Acute Myocardial Infarction II (SAMI-II) project. Int J Cardiol. 2016;219:20–24.
18.
PlakhtYShiyovichAWeitzmanSFraserDZahgerDGilutzH. A new risk score predicting 1- and 5-year mortality following acute myocardial infarction Soroka Acute Myocardial Infarction (SAMI) Project. Int J Cardiol. 2012;154(2):173–79.
19.
D’AgostinoRBSrVasanRSPencinaMJ. General cardiovascular risk profile for use in primary care: the Framingham Heart Study. Circulation. 2008;117(6):743–53.
20.
LeeMSFlammerAJLiJ. Time-trend analysis on the Framingham risk score and prevalence of cardiovascular risk factors in patients undergoing percutaneous coronary intervention without prior history of coronary vascular disease over the last 17 years: a study from the Mayo Clinic PCI registry. Clin Cardiol. 2014;37(7):408–416.
21.
LeeMSFlammerAJLiJ. Comparison of time trends of cardiovascular disease risk factors and Framingham Risk Score between patients with and without acute coronary syndrome undergoing percutaneous intervention over the last 17 years: from the Mayo Clinic Percutaneous Coronary Intervention Registry. Clin Cardiol. 2015;38(12):747–56.
22.
Gonzalez-PachecoHVargas-BarronJVallejoM. Prevalence of conventional risk factors and lipid profiles in patients with acute coronary syndrome and significant coronary disease. Ther Clin Risk Manag. 2014;10:815–23.
23.
GreenlandPKnollMDStamlerJ. Major risk factors as antecedents of fatal and nonfatal coronary heart disease events. JAMA. 2003;290(7):891–97.
24.
PlakhtYGilutzHShiyovichAZahgerDWeitzmanS. Gender and ethnic disparities in outcome following acute myocardial infarction among Bedouins and Jews in southern Israel. Eur J Public Health. 2011;21(1):74–80.
25.
RoeMTHalabiARMehtaRH. Documented traditional cardiovascular risk factors and mortality in non-ST-segment elevation myocardial infarction. Am Heart J. 2007;153(4):507–514.
26.
CantoJGKiefeCIRogersWJ; NRMI Investigators. Atherosclerotic risk factors and their association with hospital mortality among patients with first myocardial infarction (from the National Registry of Myocardial Infarction). Am J Cardiol. 2012;110(9):1256–61.
27.
SaabFMukherjeeDGurmH. Risk Factors in first presentation acute coronary syndromes (ACS): how do we move from population to individualized risk prediction?Angiology. 2009;60(6):663–67.
28.
AgarwalSSudKThakkarBMenonVJaberWAKapadiaSR. Changing trends of atherosclerotic risk factors among patients with acute myocardial infarction and acute ischemic stroke. Am J Cardiol. 2017;119(10):1532–41.
29.
ShahBBangaloreSGianosE. Temporal trends in clinical characteristics of patients without known cardiovascular disease with a first episode of myocardial infarction. Am Heart J. 2014;167(4):480–8 e481.
30.
LeeMSFlammerAJKimHS. The prevalence of cardiovascular disease risk factors and the Framingham Risk Score in patients undergoing percutaneous intervention over the last 17 years by gender: time-trend analysis from the Mayo Clinic PCI Registry. J Prev Med Public Health. 2014;47(4):216–29.
31.
NCD Risk Factor Collaboration. Worldwide trends in diabetes since 1980: a pooled analysis of 751 population-based studies with 4.4 million participants. Lancet. 2016;387(10027):1513–30.
32.
NCD Risk Factor Collaboration. Trends in adult body-mass index in 200 countries from 1975 to 2014: a pooled analysis of 1698 population-based measurement studies with 19.2 million participants. Lancet. 2016;387(10027):1377–96.
33.
RabaniSSardariniaMAkbarpourSAziziFKhaliliDHadaeghF. 12-year trends in cardiovascular risk factors (2002-2005 through 2011-2014) in patients with cardiovascular diseases: Tehran lipid and glucose study. PloS One. 2018;13(5):e0195543.
34.
MuntnerPDeSalvoKBWildmanRPRaggiPHeJWheltonPK. Trends in the prevalence, awareness, treatment, and control of cardiovascular disease risk factors among noninstitutionalized patients with a history of myocardial infarction and stroke. Am J Epidemiol. 2006;163(10):913–20.
35.
ArbelYMatetzkySGavrielov-YusimN. Temporal trends in all-cause mortality of smokers versus non-smokers hospitalized with ST-segment elevation myocardial infarction. Int J Cardiol. 2014;176(1):171–76.
36.
LeviAChezar-AzerradCHasdaiD. Impact of self-reported family history of premature cardiovascular disease on the outcomes of patients hospitalized for acute coronary syndrome (from the Acute Coronary Syndrome Israel Survey [ACSIS] 2000 to 2013). Am J Cardiol. 2018;122(6):917–21.
37.
PrabhakaranDJeemonP. Should your family history of coronary heart disease scare you?The Mt Sinai J Med. 2012;79(6):721–32.
38.
CutlerJASorliePDWolzMThomTFieldsLERoccellaEJ. Trends in hypertension prevalence, awareness, treatment, and control rates in United States adults between 1988-1994 and 1999-2004. Hypertension. 2008;52(5):818–27.
39.
HoergerTJZhangPSegelJEGreggEWNarayanKMHicksKA. Improvements in risk factor control among persons with diabetes in the United States: evidence and implications for remaining life expectancy. Diabetes Res Clinical Pract. 2009;86:225–32.
40.
SteinbergBABhattDLMehtaS. Nine-year trends in achievement of risk factor goals in the US and European outpatients with cardiovascular disease. Am Heart J. 2008;156(4):719–27.
41.
NewbyDEFoxKA. Unstable angina: the first 48 hours and later in-hospital management. Br Med Bull. 2001;59:69–87.
42.
GoASIribarrenCChandraM; Atherosclerotic Disease, Vascular Function and Genetic Epidemiology (ADVANCE) Study. Statin and beta-blocker therapy and the initial presentation of coronary heart disease. Ann Intern Med. 2006;144(4):229–38.
43.
ColesAHFisherKADarlingC. Recent trends in post-discharge mortality among patients with an initial acute myocardial infarction. Am J Cardiol. 2012;110(8):1073–77.
44.
PalmeriniTBenedettoUBiondi-ZoccaiG. Long-term safety of drug-eluting and bare-metal stents: evidence from a comprehensive network meta-analysis. J Am Coll Cardiol. 2015;65(23):2496–2507.
45.
ParikhNIGonaPLarsonMG. Long-term trends in myocardial infarction incidence and case fatality in the National Heart, Lung, and Blood Institute’s Framingham Heart study. Circulation. 2009;119(9):1203–10.
46.
AmitGGilutzHCafriCWolakAIliaRZahgerD. What have the new definition of acute myocardial infarction and the introduction of troponin measurement done to the coronary care unit? Impacts on admission rate, length of stay, case mix and mortality. Cardiology. 2004;102(3):171–76.
47.
MelkiDLugnegardJAlfredssonJ. Implications of introducing high-sensitivity cardiac troponin T into clinical practice: data from the SWEDEHEART Registry. J Am Colle Cardiol. 2015;65(16):1655–64.
48.
ThygesenKAlpertJSJaffeAS; ESC Scientific Document Group. Fourth universal definition of myocardial infarction. Eur Heart J. 2019;40(3):237–69. doi:10.1093/eurheartj/ehy462
49.
MetcalfeANeudamAFordeS. Case definitions for acute myocardial infarction in administrative databases and their impact on in-hospital mortality rates. Health Serv Res. 2013;48(1):290–318.
