The epidemiology of myocardial infarction. Trends in incidence, risk factors, severity, treatment and outcomes of myocardial infarction in a general population.
Paper 1 and 2 were based on the Tromsø Study, a population-based, prospective cohort study with repeated screenings for cardiovascular risk factors and follow-up with regard to disease incidence and mortality. Paper 3 was based on a local registry of consecutively patients with presumed ST-elevation...
Published in: | Circulation |
---|---|
Main Author: | |
Format: | Doctoral or Postdoctoral Thesis |
Language: | English |
Published: |
UiT The Arctic University of Norway
2019
|
Subjects: | |
Online Access: | https://hdl.handle.net/10037/17042 |
id |
ftunivtroemsoe:oai:munin.uit.no:10037/17042 |
---|---|
record_format |
openpolar |
institution |
Open Polar |
collection |
University of Tromsø: Munin Open Research Archive |
op_collection_id |
ftunivtroemsoe |
language |
English |
topic |
VDP::Medisinske Fag: 700::Klinisk medisinske fag: 750::Kardiologi: 771 VDP::Medical disciplines: 700::Clinical medical disciplines: 750::Cardiology: 771 VDP::Medisinske Fag: 700::Helsefag: 800::Epidemiologi medisinsk og odontologisk statistikk: 803 VDP::Medical disciplines: 700::Health sciences: 800::Epidemiology medical and dental statistics: 803 The Tromsø Study Tromsøundersøkelsen DOKTOR-003 |
spellingShingle |
VDP::Medisinske Fag: 700::Klinisk medisinske fag: 750::Kardiologi: 771 VDP::Medical disciplines: 700::Clinical medical disciplines: 750::Cardiology: 771 VDP::Medisinske Fag: 700::Helsefag: 800::Epidemiologi medisinsk og odontologisk statistikk: 803 VDP::Medical disciplines: 700::Health sciences: 800::Epidemiology medical and dental statistics: 803 The Tromsø Study Tromsøundersøkelsen DOKTOR-003 Mannsverk, Jan Torbjørn The epidemiology of myocardial infarction. Trends in incidence, risk factors, severity, treatment and outcomes of myocardial infarction in a general population. |
topic_facet |
VDP::Medisinske Fag: 700::Klinisk medisinske fag: 750::Kardiologi: 771 VDP::Medical disciplines: 700::Clinical medical disciplines: 750::Cardiology: 771 VDP::Medisinske Fag: 700::Helsefag: 800::Epidemiologi medisinsk og odontologisk statistikk: 803 VDP::Medical disciplines: 700::Health sciences: 800::Epidemiology medical and dental statistics: 803 The Tromsø Study Tromsøundersøkelsen DOKTOR-003 |
description |
Paper 1 and 2 were based on the Tromsø Study, a population-based, prospective cohort study with repeated screenings for cardiovascular risk factors and follow-up with regard to disease incidence and mortality. Paper 3 was based on a local registry of consecutively patients with presumed ST-elevation myocardial infarction who had been given prehospital thrombolytic therapy, and then admitted to the University Hospital in Tromsø. In paper 1, we showed that a substantial part of the decline in coronary heart disease mortality in the young and middle-aged population was due to a decreased incidence of myocardial infarction. The study indicates that the population burden of coronary heart disease may be shifting towards women and elderly patients, suggesting that preventive gains have not penetrated equally throughout the population. The severity and case fatality of the disease, however, was declining in all groups. In paper 2, we found that age- and sex-adjusted incidence of total coronary heart disease decreased by 3% annually over 15 years of follow-up. The decrease was found primarily in reductions in out-of-hospital sudden cardiac death and hospitalized ST-elevation myocardial infarction. Reductions in serum cholesterol accounted for approximately one-third of the event decline, but decreases in smoking, blood pressure, and heart rate and increased physical activity all contributed. Increases in body mass index and diabetes mellitus were associated with modest increases in disease outcomes. Overall, risk factors accounted for 66% of the decline in incidence. Furthermore, the decline in event rates and the decline in case fatality each explained 50% of the decline in coronary heart disease mortality. This was partly explained by less severe disease in those afflicted, but also by a major improvement in treatment. In paper 3, we showed that ambulance clinicians with the support of hospital cardiologists could safely and effectively perform prehospital thrombolytic therapy. The implementation of this system was associated with significant reduction in time delays of reperfusion therapy, and reduction in post-infarct systolic heart failure, and high survival rates among ST-elevation myocardial infarction-patients suffering out-of hospital cardiac arrest. |
format |
Doctoral or Postdoctoral Thesis |
author |
Mannsverk, Jan Torbjørn |
author_facet |
Mannsverk, Jan Torbjørn |
author_sort |
Mannsverk, Jan Torbjørn |
title |
The epidemiology of myocardial infarction. Trends in incidence, risk factors, severity, treatment and outcomes of myocardial infarction in a general population. |
title_short |
The epidemiology of myocardial infarction. Trends in incidence, risk factors, severity, treatment and outcomes of myocardial infarction in a general population. |
title_full |
The epidemiology of myocardial infarction. Trends in incidence, risk factors, severity, treatment and outcomes of myocardial infarction in a general population. |
title_fullStr |
The epidemiology of myocardial infarction. Trends in incidence, risk factors, severity, treatment and outcomes of myocardial infarction in a general population. |
title_full_unstemmed |
The epidemiology of myocardial infarction. Trends in incidence, risk factors, severity, treatment and outcomes of myocardial infarction in a general population. |
title_sort |
epidemiology of myocardial infarction. trends in incidence, risk factors, severity, treatment and outcomes of myocardial infarction in a general population. |
publisher |
UiT The Arctic University of Norway |
publishDate |
2019 |
url |
https://hdl.handle.net/10037/17042 |
geographic |
Tromsø |
geographic_facet |
Tromsø |
genre |
Arctic Tromsø |
genre_facet |
Arctic Tromsø |
op_relation |
Paper 1: Mannsverk, J., Wilsgaard, T., Njølstad, I., Hopstock, L.A., Løchen, M.L., Mathiesen, E.B. … Bønaa. K.H. (2012). Age and gender differences in incidence and case fatality trends for myocardial infarction: a 30-year follow-up. The Tromsø Study. European Journal of Preventive Cardiology, 19 (5), 927-934. Also available at https://doi.org/10.1177%2F1741826711421081 . Paper 2: Mannsverk, J., Wilsgaard, T., Mathiesen, E.B., Løchen, M.L., Rasmussen, K., Thelle, D.S., … Bønaa, K.H. (2016). Trends in modifiable risk factors are associated with declining incidence of hospitalized and nonhospitalized acute coronary heart disease in a population. Circulation, 133 (1), 74–81. Also available at https://doi.org/10.1161/CIRCULATIONAHA.115.016960 . Paper 3: Mannsverk, J., Steigen, T., Wang, H., Tande, P.M., Dahle, B.M., Nedrejord, M.L., … Gilbert, M. (2019). Trends in clinical outcomes and survival following prehospital thrombolytic therapy given by ambulance clinicians for ST-elevation myocardial infarction in rural sub-arctic Norway. European Heart Journal: Acute Cardiovascular Care, 8 (1), 8-14. Also available at https://doi.org/10.1177%2F2048872617748550 . 978-82-7589-651-1 https://hdl.handle.net/10037/17042 |
op_rights |
embargoedAccess Copyright 2019 The Author(s) |
op_doi |
https://doi.org/10.1161/CIRCULATIONAHA.115.016960 |
container_title |
Circulation |
container_volume |
133 |
container_issue |
1 |
container_start_page |
74 |
op_container_end_page |
81 |
_version_ |
1766302340017553408 |
spelling |
ftunivtroemsoe:oai:munin.uit.no:10037/17042 2023-05-15T14:28:11+02:00 The epidemiology of myocardial infarction. Trends in incidence, risk factors, severity, treatment and outcomes of myocardial infarction in a general population. Mannsverk, Jan Torbjørn 2019-11-07 https://hdl.handle.net/10037/17042 eng eng UiT The Arctic University of Norway UiT Norges arktiske universitet Paper 1: Mannsverk, J., Wilsgaard, T., Njølstad, I., Hopstock, L.A., Løchen, M.L., Mathiesen, E.B. … Bønaa. K.H. (2012). Age and gender differences in incidence and case fatality trends for myocardial infarction: a 30-year follow-up. The Tromsø Study. European Journal of Preventive Cardiology, 19 (5), 927-934. Also available at https://doi.org/10.1177%2F1741826711421081 . Paper 2: Mannsverk, J., Wilsgaard, T., Mathiesen, E.B., Løchen, M.L., Rasmussen, K., Thelle, D.S., … Bønaa, K.H. (2016). Trends in modifiable risk factors are associated with declining incidence of hospitalized and nonhospitalized acute coronary heart disease in a population. Circulation, 133 (1), 74–81. Also available at https://doi.org/10.1161/CIRCULATIONAHA.115.016960 . Paper 3: Mannsverk, J., Steigen, T., Wang, H., Tande, P.M., Dahle, B.M., Nedrejord, M.L., … Gilbert, M. (2019). Trends in clinical outcomes and survival following prehospital thrombolytic therapy given by ambulance clinicians for ST-elevation myocardial infarction in rural sub-arctic Norway. European Heart Journal: Acute Cardiovascular Care, 8 (1), 8-14. Also available at https://doi.org/10.1177%2F2048872617748550 . 978-82-7589-651-1 https://hdl.handle.net/10037/17042 embargoedAccess Copyright 2019 The Author(s) VDP::Medisinske Fag: 700::Klinisk medisinske fag: 750::Kardiologi: 771 VDP::Medical disciplines: 700::Clinical medical disciplines: 750::Cardiology: 771 VDP::Medisinske Fag: 700::Helsefag: 800::Epidemiologi medisinsk og odontologisk statistikk: 803 VDP::Medical disciplines: 700::Health sciences: 800::Epidemiology medical and dental statistics: 803 The Tromsø Study Tromsøundersøkelsen DOKTOR-003 Doctoral thesis Doktorgradsavhandling 2019 ftunivtroemsoe https://doi.org/10.1161/CIRCULATIONAHA.115.016960 2021-06-25T17:57:04Z Paper 1 and 2 were based on the Tromsø Study, a population-based, prospective cohort study with repeated screenings for cardiovascular risk factors and follow-up with regard to disease incidence and mortality. Paper 3 was based on a local registry of consecutively patients with presumed ST-elevation myocardial infarction who had been given prehospital thrombolytic therapy, and then admitted to the University Hospital in Tromsø. In paper 1, we showed that a substantial part of the decline in coronary heart disease mortality in the young and middle-aged population was due to a decreased incidence of myocardial infarction. The study indicates that the population burden of coronary heart disease may be shifting towards women and elderly patients, suggesting that preventive gains have not penetrated equally throughout the population. The severity and case fatality of the disease, however, was declining in all groups. In paper 2, we found that age- and sex-adjusted incidence of total coronary heart disease decreased by 3% annually over 15 years of follow-up. The decrease was found primarily in reductions in out-of-hospital sudden cardiac death and hospitalized ST-elevation myocardial infarction. Reductions in serum cholesterol accounted for approximately one-third of the event decline, but decreases in smoking, blood pressure, and heart rate and increased physical activity all contributed. Increases in body mass index and diabetes mellitus were associated with modest increases in disease outcomes. Overall, risk factors accounted for 66% of the decline in incidence. Furthermore, the decline in event rates and the decline in case fatality each explained 50% of the decline in coronary heart disease mortality. This was partly explained by less severe disease in those afflicted, but also by a major improvement in treatment. In paper 3, we showed that ambulance clinicians with the support of hospital cardiologists could safely and effectively perform prehospital thrombolytic therapy. The implementation of this system was associated with significant reduction in time delays of reperfusion therapy, and reduction in post-infarct systolic heart failure, and high survival rates among ST-elevation myocardial infarction-patients suffering out-of hospital cardiac arrest. Doctoral or Postdoctoral Thesis Arctic Tromsø University of Tromsø: Munin Open Research Archive Tromsø Circulation 133 1 74 81 |