LONDON – Young and middle-age adults who survive an MI have substantially improved prospects today for having a relatively normal lifespan, compared with MI patients from the 1980s, according to data from a population-based Danish study involving more than 200,000 residents.
“Long-term mortality following an MI before age 50 years decreased remarkably over the last 3 decades and is approaching the long-term mortality of the general Danish population,” Dr. Morten Schmidt said at the annual congress of the European Society of Cardiology.
But while the absolute long-term mortality among patients who have an MI when they are less than 50 years old is now low and substantially reduced from what it was in the 1980s, the death rate among these patients is still roughly twice the rate seen in the general population and is primarily the result of ischemic heart disease and smoking-related diseases, he said.
This enduring excess risk means that young MI survivors need to continue to adhere to prescribed medical therapies and to implement lifestyle changes such as smoking cessation and increased physical activity, said Dr. Schmidt, a clinical epidemiologist at Aarhus (Denmark) University. He attributed the risk reduction that occurred from the 1980s through the 2000s to coronary intervention strategies and medical treatment for secondary prevention.
Dr. Schmidt and his associates examined mortality trends among young MI survivors using data available through the population-based registries maintained by the Danish National Health Service. As of 2009, 21,693 Danish adults younger than 50 years old had had a MI. Investigators matched them by age, gender, and year of MI on a 1:10 basis with 216,930 Danes who had no MI history. The MI patients averaged 45 years old, 84% were 40-49 years old, and 80% were men. Somewhat more than one third of the MIs occurred in 1980-1989, and slightly less than a third occurred in 1990-1999, and slightly less than a third in 2000-2009. The researchers tracked the outcomes of the MI survivors and controls through the end of 2012.
The findings showed that 10-year mortality among patients who survived for at least 1 year following their MI dropped from 24% among patients who had their MI in the 1980s to 9% among those with an MI in the 2000s.
When the researchers compared subjects’ mortality with that of the matched general population and also adjusted for comorbidities, they found that the excess 10-year mortality among MI survivors dropped from nearly fivefold above the all-cause death rate of general population during the 1980s to about a twofold increase among the MI survivors from the 2000s. During the 2000s, for every 1,000 people younger than 50 years of age who had an MI and survived for at least 1 year, six additional deaths occurred per year during each of the subsequent 9 years, compared with the general Danish population. In contrast, the MI survivors from the 1980s had an excess of 25 deaths per year, compared with the general population, for every 1,000 MI survivors who lived for at least 1 year.
Dr. Schmidt had no disclosures.
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