Divergent trends in the incidence and mortality of coronary events, especially in women. Evidence from Finland in 1996-2021.

ObjectiveAcute coronary syndrome (ACS) incidence and case fatality (CF) have declined in the past decades, but some studies have suggested a potential stagnation in this decline. We examined how the ACS burden has evolved among persons aged 35-74 in Finland from 1996 to 2021. MethodsWe used Finnish country-wide Hospital Discharge- and Causes of Death-Registers covering first non-fatal and fatal ACS events, totaling 69 906 442 person-years at risk. We analyzed incidence, mortality, and 28-day CF, and their trends using negative binomial, Poisson, segmented, and logistic regression adjusting for age and sex. ResultsAltogether, the analysis consisted of 186 489 non-fatal and 72 907 fatal ACS events. ACS incidence declined in men (annual percentage change (APC) -2.0% [95% CI -2.2 to -1.8]) and in older women (APC of 55-64 year old -1.5% [-1.7 to -1.2] and 65-74 year old -3.3% [-3.4 to -3.2]), but the incidence decline slowed down over the last decade. In younger women aged 35-54, incidence was unchanged during the study period. ACS mortality and CF declined (APC of the mortality in men - 4.4% [-4.6 to -4.2] and in women -5.0% [-5.2 to -4.7]. APC of CF in men -2.7% [-2.8 to -2.6] and in women -3.3% [-3.6 to -3.1]). ConclusionsACS mortality declined in all groups, but the decline in ACS incidence slowed down and even halted in women. In women aged 35-54, the incidence was unchanged during the study period. These results emphasize the need of intensified cardiovascular prevention, particularly in women. Key messagesO_ST_ABSWhat is already known on this topicC_ST_ABSDuring the last decades coronary artery disease treatment and prevention have improved worldwide which has led to a decline in ACS mortality and case fatality. However, recent studies from several countries suggest, that incidence decline has stagnated or even turned to increase, especially in younger age cohorts. What this study addsThis study showed that incidence has ceased its decline in women aged 35-54 and has slowed down in older age groups. Together with declining mortality this results in a growing number of patients living with cardiovascular disease leading to increased healthcare costs. How this study might affect research, practice, or policyThe alarming results of this study underline the importance of intensifying prevention, focusing especially on young and middle-aged women.