Trends and predictions of metabolic risk factors for acute myocardial infarction: findings from a multiethnic nationwide cohort

Nicholas W S Chew; Bryan Chong; Si Min Kuo; Jayanth Jayabaskaran; Mingshi Cai; Huili Zheng; Rachel Goh; Gwyneth Kong; Yip Han Chin; Syed Saqib Imran; Michael Liang; Patrick Lim; Thon Hon Yong; Boon Wah Liew; Pow Li Chia; Hee Hwa Ho; David Foo; Deanna Khoo; Zijuan Huang; Terrance Chua; Jack Wei Chieh Tan; Khung Keong Yeo; Derek Hausenloy; Hui Wen Sim; Jieli Kua; Koo Hui Chan; Poay Huan Loh; Toon Wei Lim; Adrian F Low; Ping Chai; Chi Hang Lee; Tiong Cheng Yeo; James Yip; Huay Cheem Tan; Mamas A Mamas; Stephen J Nicholls; Mark Y Chan

doi:10.1016/j.lanwpc.2023.100803

Trends and predictions of metabolic risk factors for acute myocardial infarction: findings from a multiethnic nationwide cohort

Lancet Reg Health West Pac. 2023 May 31:37:100803. doi: 10.1016/j.lanwpc.2023.100803. eCollection 2023 Aug.

Authors

Nicholas W S Chew^{1

2}, Bryan Chong¹, Si Min Kuo³, Jayanth Jayabaskaran¹, Mingshi Cai³, Huili Zheng⁴, Rachel Goh¹, Gwyneth Kong¹, Yip Han Chin¹, Syed Saqib Imran⁴, Michael Liang⁴, Patrick Lim⁴, Thon Hon Yong⁵, Boon Wah Liew⁵, Pow Li Chia⁶, Hee Hwa Ho⁶, David Foo⁶, Deanna Khoo⁶, Zijuan Huang⁷, Terrance Chua⁷, Jack Wei Chieh Tan⁷, Khung Keong Yeo⁷, Derek Hausenloy^{1

8

9

10}, Hui Wen Sim^{2

11}, Jieli Kua^{2

11}, Koo Hui Chan^{1

2}, Poay Huan Loh^{1

2

11}, Toon Wei Lim^{1

2}, Adrian F Low^{1

2}, Ping Chai^{1

2}, Chi Hang Lee^{1

2}, Tiong Cheng Yeo^{1

2}, James Yip^{1

2}, Huay Cheem Tan^{1

2}, Mamas A Mamas^{12

13}, Stephen J Nicholls^{14

15}, Mark Y Chan^{1

2}

Affiliations

¹ Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
² Department of Cardiology, National University Heart Centre, National University Health System, Singapore.
³ Policy, Research and Surveillance Division, Health Promotion Board, Singapore.
⁴ Khoo Teck Puat Hospital, Singapore.
⁵ Changi General Hospital, Singapore.
⁶ Tan Tock Seng Hospital, Singapore.
⁷ Department of Cardiology, National Heart Centre, Singapore.
⁸ Cardiovascular & Metabolic Disorders Program, Duke-National University of Singapore Medical School, Singapore.
⁹ National Heart Research Institute Singapore, National Heart Centre, Singapore.
¹⁰ The Hatter Cardiovascular Institute, University College London, London, UK.
¹¹ Department of Cardiology, Ng Teng Fong General Hospital, Singapore.
¹² Institute of Population Health, University of Manchester, Manchester, UK.
¹³ Keele Cardiac Research Group, Centre for Prognosis Research, Keele University, Stoke-on-Trent, UK.
¹⁴ Victorian Heart Institute, Melbourne, Australia.
¹⁵ Monash Heart, Monash Health, Melbourne, Australia.

Abstract

Background: Understanding the trajectories of metabolic risk factors for acute myocardial infarction (AMI) is necessary for healthcare policymaking. We estimated future projections of the incidence of metabolic diseases in a multi-ethnic population with AMI.

Methods: The incidence and mortality contributed by metabolic risk factors in the population with AMI (diabetes mellitus [T2DM], hypertension, hyperlipidemia, overweight/obesity, active/previous smokers) were projected up to year 2050, using linear and Poisson regression models based on the Singapore Myocardial Infarction Registry from 2007 to 2018. Forecast analysis was stratified based on age, sex and ethnicity.

Findings: From 2025 to 2050, the incidence of AMI is predicted to rise by 194.4% from 482 to 1418 per 100,000 population. The largest percentage increase in metabolic risk factors within the population with AMI is projected to be overweight/obesity (880.0% increase), followed by hypertension (248.7% increase), T2DM (215.7% increase), hyperlipidemia (205.0% increase), and active/previous smoking (164.8% increase). The number of AMI-related deaths is expected to increase by 294.7% in individuals with overweight/obesity, while mortality is predicted to decrease by 11.7% in hyperlipidemia, 29.9% in hypertension, 32.7% in T2DM and 49.6% in active/previous smokers, from 2025 to 2050. Compared with Chinese individuals, Indian and Malay individuals bear a disproportionate burden of overweight/obesity incidence and AMI-related mortality.

Interpretation: The incidence of AMI is projected to continue rising in the coming decades. Overweight/obesity will emerge as fastest-growing metabolic risk factor and the leading risk factor for AMI-related mortality.

Funding: This research was supported by the NUHS Seed Fund (NUHSRO/2022/058/RO5+6/Seed-Mar/03) and National Medical Research Council Research Training Fellowship (MOH-001131). The SMIR is a national, ministry-funded registry run by the National Registry of Diseases Office and funded by the Ministry of Health, Singapore.

Keywords: Acute myocardial infarction; Incidence; Metabolic risk factors; Mortality; Public health.