Gender differences in trends of acute myocardial infarction events: The Northern Sweden MONICA study 1985 – 2004

Diagnosed MI events in subjects aged 25–64 years in the Counties of Norrbotten and V？sterbotten were validated according to the MONICA protocol. The total number of events registered up to January 1, 2005 was 11,763: 9,387 in men and 2,376 in women.The proportion of male/female events has decreased from 5.5:1 to 3:1. For males the reductions were 30% and 70% for first and recurrent MI, respectively, and for women 0% and 40% in the 55–64 year group. For both sexes a 50% reduction in 28-day case fatality was seen in the 25–64 year-group. Mortality was reduced by 69% and 45% in men and women, respectively.First and recurrent events of myocardial infarction was markedly reduced in men over the 20-year observation period, but for women the reduction was seen only for recurrent infarctions. Case fatality, on the other hand, was markedly reduced for both sexes. As a result of the positive effects on incidence and case fatality a substantial reduction was seen in total mortality, most pronounced for men.Coronary heart disease (CHD) is the leading cause of death in Sweden as well as in most Western European countries and in the United States. Incidence and mortality rates in CHD have decreased substantially during the last decades, and this trend seems to continue [1-4].At the start of the MONICA project in 1985 the incidence of, and mortality due to, myocardial infarction (MI) in the two northernmost counties in Sweden were the highest in the country. However, they have gradually approached the national average indicating a faster reduction in Northern Sweden than in the rest of the country [5]. Generally, in the Western world, the decreased mortality in CHD is due to a combination of declining incidence and improved survival. Better primary prevention and improvements in acute coronary care, including secondary prevention, may explain these impressing achievements [1].Gender differences in both events and case-fatality, and thereby also in mortality due to CHD, have been s