Acute Myocardial Infarction Morbidity Research Articles

Impact of comprehensive air pollution control policies on six criteria air pollutants and acute myocardial infarction morbidity, Weifang, China: A quasi-experimental study

Comprehensive air pollution control policies may reduce pollutant emissions. However, the impact on disease morbidity of the change for the concentration of air pollutants following the policies has been insufficiently studied. We aim to assess the impact of comprehensive air pollution control policies on the levels of six criteria air pollutants and acute myocardial infarction (AMI) morbidity in Weifang, China. This study performed an interrupted time series analysis. The linear model with spline terms and generalized additive quasi-Poisson model were used to estimate the immediate change from 2016 to 2019 in the daily concentration of six air pollutants (PM2.5, PM10, SO2, NO2, O3, and, CO) and AMI incident cases (Age ≥35) associated with the implementation of air pollution control policies in Weifang, respectively. After the implementation of air pollution control policies, air quality in Weifang had been improved. Specifically, the daily concentrations of PM2.5, PM10, SO2, and, CO immediately decreased by 27.9 % (95 % CI: 6.6 % to 44.3 %), 32.9 % (95 % CI: 17.5 % to 45.5 %), 14.6 % (95 % CI: 0.4 % to 26.8 %), and 33.9 % (95 % CI: 22.0 % to 44.0 %), respectively. In addition, the policies implementation was also associate with the immediate decline in the AMI morbidity (−6.5 %, 95 % CI: −10.4 % to −2.3 %). And subgroup analyses indicate that the health effects of the policy intervention were only observed in female (−9.4 %, 95 % CI: −14.4 % to −4.2 %) and those aged ≥65 years (−10.5 %, 95 % CI: −14.6 % to −6.2 %). During the final 20 months of the study period, the policy intervention was estimated to prevent 1603 (95 % CI: 574 to 2587) cases of incident AMI in Weifang. Our results provide strong rationale that the policy intervention significantly reduced ambient pollutant concentrations and AMI morbidity, which highlighted the importance for a comprehensive and rigorous air pollution control policy in regions with severe air pollution.

Impacts of birthplace and complications on the association between cold exposure and acute myocardial infarction morbidity in the Migrant City: A time-series study in Shenzhen, China

• Cold exposure may induce AMI morbidity, males, the elderly, and the low-educated are relevant vulnerable populations. • In the immigrant city, people from southern regions are more vulnerable to cold exposure compared with those from northern regions. • People with hypertension and/or diabetes are more vulnerable to cold exposure compared with those without these diseases.

Importance of applying Mixed Generalized Additive Model (MGAM) as a method for assessing the environmental health impacts: Ambient temperature and Acute Myocardial Infarction (AMI), among elderly in Shanghai, China.

Association between acute myocardial infarction (AMI) morbidity and ambient temperature has been examined with generalized linear model (GLM) or generalized additive model (GAM). However, the effect size by these two methods might be biased due to the autocorrelation of time series data and arbitrary selection of degree of freedom of natural cubic splines. The present study analyzed how the climatic factors affected AMI morbidity for older adults in Shanghai with Mixed generalized additive model (MGAM) that addressed these shortcomings mentioned. Autoregressive random effect was used to model the relationship between AMI and temperature, PM10, week days and time. The degree of freedom of time was chosen based on the seasonal pattern of temperature. The performance of MGAM was compared with GAM on autocorrelation function (ACF), partial autocorrelation function (PACF) and goodness of fit. One-year predictions of AMI counts in 2011 were conducted using MGAM with the moving average. Between 2007 and 2011, MGAM adjusted the autocorrelation of AMI time series and captured the seasonal pattern after choosing the degree of freedom of time at 5. Using MGAM, results were well fitted with data in terms of both internal (R2 = 0.86) and external validity (correlation coefficient = 0.85). The risk of AMI was relatively high in low temperature (Risk ratio = 0.988 (95% CI 0.984, 0.993) for under 12°C) and decreased as temperature increased and speeded up within the temperature zone from 12°C to 26°C (Risk ratio = 0.975 (95% CI 0.971, 0.979), but it become increasing again when it is 26°C although not significantly (Risk ratio = 0.999 (95% CI 0.986, 1.012). MGAM is more appropriate than GAM in the scenario of response variable with autocorrelation and predictors with seasonal variation. The risk of AMI was comparatively higher when temperature was lower than 12°C in Shanghai as a typical representative location of subtropical climate.

Effect of Short-Term Exposure to Fine Particulate Matter and Temperature on Acute Myocardial Infarction in Korea.

Background/Aim: Previous studies have suggested that the short-term ambient air pollution and temperature are associated with myocardial infarction. In this study, we aimed to conduct a time-series analysis to assess the impact of fine particulate matter (PM2.5) and temperature on acute myocardial infarction (AMI) among adults over 20 years of age in Korea by using the data from the Korean National Health Information Database (KNHID). Methods: The daily data of 192,567 AMI cases in Seoul were collected from the nationwide, population-based KNHID from 2005 to 2014. The monitoring data of ambient PM2.5 from the Seoul Research Institute of Public Health and Environment were also collected. A generalized additive model (GAM) that allowed for a quasi-Poisson distribution was used to analyze the effects of PM2.5 and temperature on the incidence of AMI. Results: The models with PM2.5 lag structures of lag 0 and 2-day averages of lag 0 and 1 (lag 01) showed significant associations with AMI (Relative risk [RR]: 1.011, CI: 1.003–1.020 for lag 0, RR: 1.010, CI: 1.000–1.020 for lag 01) after adjusting the covariates. Stratification analysis conducted in the cold season (October–April) and the warm season (May–September) showed a significant lag 0 effect for AMI cases in the cold season only. Conclusions: In conclusion, acute exposure to PM2.5 was significantly associated with AMI morbidity at lag 0 in Seoul, Korea. This increased risk was also observed at low temperatures.

Epidemiological trends in mortality, event rates and case fatality of acute myocardial infarction from 2004 to 2015: results from the KORA MI registry

Aim This study examines epidemiological trends of acute myocardial infarction (AMI) in Germany from 2004–2015 across different age groups, using data of the population-based KORA myocardial infarction registry. Methods Annual age-standardised, age-group- and sex-specific mortality and event rates (incident and recurrent) per 100,000 population as well as 28-day case fatality were calculated from all registered cases of AMI and coronary heart disease deaths in 25–74-year-olds from 2004–2015 and 75–84-year-olds from 2009–2015. Average annual percentage changes (AAPC) were calculated by joinpoint regression. Results Mortality rates declined considerably among the elderly (75–84 years), in men by –6.0% annually, due to declines of case fatality by –3.0% and incidence rate by 3.4% and in women by –10.0%, driven by declines in incidence (–9.1%) and recurrence rate (–4.9%). Significant mortality declines also occurred in males, 65–74 years of age (AAPC –3.8%). Among the age groups 25–54 years and 55–64 years, there was no substantial decline in mortality, event rates or case fatality except for a decline of incidence rate in 55–64-year-old men (AAPC –1.8%). Conclusion Inhomogeneous AMI trends across age-groups indicate progress in prevention and treatment for the population >64 years, while among <55-year-olds, we found no significant trend in AMI morbidity and mortality. KEY MESSAGES Age standardised AMI mortality continued to decline from 2009 to 2015 in the study region. Declines in AMI mortality were driven by declines in event rates (both incidence and recurrence rates) and case fatality. AMI trends were inconsistent across different age groups with the strongest declines in mortality and event rates among the elderly population (75–84 years of age).

Wire Crossing Time Correlate with Left Ventricular End-Diastolic Pressure in Patients with ST Segment Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention

Backgrounds: Mortality and morbidity in acute myocardial infarction depend on the extent of the infarct area. Rapid recovery of coronary artery blood flow with primary percutaneous coronary intervention (pPCI) can limit the extent of infarction and improve left ventricular function. Acute myocardial infarction reduce diastolic function, which in the early stage of diastolic dysfunction, there is an increase in left ventricular end-diastolic pressure (LVEDP). The non-invasive marker of E/e’ ratio is an accurate parameter of increased LVEDP.Methods: This was a cross-sectional study enrolled consecutive patients with ST Segment Elevation Myocardial Infarction (STEMI) who underwent pPCI at Dr. Sardjito Hospital. The wire crossing time was calculated from the onset of chest pain until the guidewire crossed the infarct-related artery during the pPCI procedure. The E/e’ ratio was determined by transthoracic echocardiography which performed within 48 hours after the primary PCI. Correlation between the wire crossing time and the E/e’ ratio was assessed by the Pearson correlation test. The value of p &lt;0.05 was considered statistically significant.Results: A total of 40 patients were enrolled in this study. The mean wire crossing time was 12.73±5.22 hours. The median value of the E/e’ ratio was 8.36 (range: 4.71-22.00). There was a moderate strength and significant correlation between the wire crossing time and the E/e’ ratio (r = 0.572; p &lt;0.001). Patients with E/e’ ratio &gt;15 had significantly longer wire crossing time than in patient with E/e’ ratio ≤15 (20.21±2.5 hours vs. 11.41±4.39 hours; p &lt;0.001; respectively). The wire crossing time was independently associated the E/e’ ratio (r = 0.463; p = 0.003).Conclusion: There was a moderate strength and significant positive correlation between the wire crossing time and increased LVEDP, an earlier marker of diastolic dysfunction, measured by E/e’ ratio using TTE in patients with STEMI underwent pPCI.

Anabolic steroid excess and myocardial infarction: From ischemia to reperfusion injury

Anabolic steroids (AS) are synthetic testosterone-derivatives developed by the pharmaceutical industry to mimic testosterone biological effects. So far, AS have been implicated in the treatment of pathological conditions, such as hypogonadism, anemia, and cachexia. Since their discovery, though, AS have been illicitly used by elite and recreational athletes, bodybuilders and weightlifters in order to enhance athletic and aesthetic performance. This practice is characterized by cycles of administration and withdrawal, the combination of different AS compounds, and administration of doses 50 – 1000 times higher than those recommended for therapeutic purposes. AS excess has been correlated to cardiovascular detrimental effects, including cardiac hypertrophy, arrhythmias, and hypertension. Particularly, acute myocardial infarction (AMI) has been extensively reported by clinical and post-mortem studies. Atherosclerosis, hypercoagulability state, increased thrombogenesis and vasospasm have arisen as potential causes of myocardial ischemia in AS users. Additionally, several experimental reports have demonstrated that AS can increase the susceptibility to cardiac ischemia/reperfusion injury, whereas the cardioprotection elicited by physical exercise and ischemic postconditioning is blunted. Altogether, these factors can contribute to increased AMI morbidity and mortality during AS excess, particularly when AS are combined with other compounds, such as thyroid hormones, growth hormones, insulin, and diuretics.

Association between ambient fine particulate matter and seasonal variation in acute myocardial infarction morbidity

TPS 683: Short-term health effects of air pollutants 2, Exhibition Hall, Ground floor, August 28, 2019, 3:00 PM - 4:30 PM Background/Aim: Environmental factors may play a role in the development of cardiovascular diseases and some studies have shown that ambient air pollution is associated with the myocardial infarction. This study was designed to investigate the impact of ambient air pollution on acute myocardial infarction (AMI) among adult over 20 years of age in Korea by using the data from the Korean National Health Information Database (KNHID) Methods: This study used the nationwide, population-based database from the KNHID collected between 2002 and 2015. Data analysis was performed from January 1, 2005 to December 31, 2014 since the ambient fine particulate matter (PM2.5) monitoring data from Seoul Research Institute of Public Health and Environment were available in these periods. Data on 197,940 AMI case counts in Seoul were collected. Meteorological data were collected from the Korea Meteorological Administration (KMA). We used the Poisson regression analysis adjusted for calendar time, current-day temperature, dew-point temperature, relative humidity to explore the association between PM2.5 and AMI. Results: The mean daily PM2.5 concentrations was 25.9μg/m3 with a range from 23.0 to 544μg/m3. In the Poisson regression analysis of PM2.5, the models with lag structures of lag 0 day and 2-day average of lags 0 and 1 (lag01) showed significant association with AMI (RR:1.017, CI:1.008-1.025 for lag0, RR:1.014, CI: 1.005-1.023 for lag01). There were dose-response relationships of PM2.5 concentration and AMI at lag0 and lag01. In the stratified analysis carried out in the cold season (October-April) and warm season (May-September) showed the significant lag 0 effect for AMI cases in the cold season only. Conclusions: In conclusions, our results have demonstrated that the PM2.5 concentration was significantly associated with AMI morbidity at lag 0 in Seoul, Korea. This increased risk was also observed in cold season and future prospective studies are needed to determine the causal association.

Redefining risk factors associated with Acute Myocardial Infarction (AMI) and to define independent predictors of mortality and morbidity in AMI

Redefining risk factors associated with Acute Myocardial Infarction (AMI) and to define independent predictors of mortality and morbidity in AMI

Air Pollution and Hospitalization for Acute Myocardial Infarction in China

There is growing interest in the association between ambient air pollution and acute myocardial infarction (AMI). The objective of this study was to explore the association in 14 Chinese cities using a time-stratified case-crossover design. We identified 80,787 hospital admissions for AMI between January 1, 2014 and December 31, 2015 from electronic hospitalization summary reports. Conditional logistic regression was used to estimate the percent changes with 95% confidence intervals (CIs) in AMI admissions in relation to an interquartile range increase in ambient air pollutant concentrations. All analyzed air pollutants, with the exception of ozone, were positively associated with daily AMI admissions on lag2 and lag3 days. An interquartile range increase in particulate matter <10 µm in aerodynamic diameter, sulfur dioxide, nitrogen dioxide, and carbon monoxide concentrations on lag2 day was significantly associated with a 0.8% (95% CI 0.1%, 1.6%), 2.0% (95% CI 1.2%, 2.9%), 2.2% (95% CI 1.4%, 3.1%), and 1.1% (95% CI 0.4%, 1.8%) increase in AMI admissions, respectively. We also observed a significant association in relation to ozone on lag4 day (percent change: 1.3%; 95% CI 0.2%, 2.4%). Subgroup analyses indicated no effect modification of risk by age (≥65 years and <65 years) or gender. In conclusion, this is the first multicity study in China, or even in other developing countries, to report the short-term effects of air pollution on AMI morbidity. Our findings contribute to the limited scientific data on the effects of ambient air pollution on AMI in developing countries.

The RHESA-CARE study: an extended baseline survey of the regional myocardial infarction registry of Saxony-Anhalt (RHESA) design and objectives

BackgroundCardiovascular disease (CVD) is a leading cause of death in Europe. In Germany, a declining mortality rate from acute myocardial infarction (AMI) has been observed in the last decades. Nevertheless, there are large differences between the federal states when looking at the mortality and morbidity of AMI. Saxony-Anhalt is one of the federal states with the highest mortality rates for AMI in Germany. In 2012, the regional myocardial infarction registry of Saxony-Anhalt (RHESA) was established to investigate the individual, infrastructural, and health care factors with respect to an urban (city of Halle) and rural (region of Altmark) population. For detailed observation the RHESA-CARE study was conducted in 2014. RHESA-CARE focuses on the symptoms during infarction, the behaviour of patients while alerting for infarction, the use of rehabilitation possibilities, and long-term care.Methods/DesignRHESA-CARE is an extended baseline survey of AMI patients registered in RHESA who are aged 25 or more, and inhabitants of the city of Halle (Saale) or the district of Altmark in the federal state of Saxony-Anhalt, Germany. Detailed information was collected on classical and psychosocial cardiovascular risk factors as well as factors of alerting behaviour, first aid, and utilization of medical and rehabilitation services. High data quality is ensured by a detailed system of quality control.DiscussionRHESA-CARE has the main objective to investigate factors that influence morbidity and mortality rates due to AMI. Another purpose is the comparison of a rural and urban patient population. It provides an opportunity to serve as a base for improvement of patients’ behaviour and health care as well as further research.

Associations of morbidity and mortality from coronary heart disease with heliogeophysical factors.

The aim of this study was to evaluate the associations among morbidity of acute myocardial infarction (AMI) and mortality from ischemic heart disease (IHD) with heliogeophysical factors among the Kaunas population. The study population was stratified into three age categories: 25-54, 55-64, and ≥65years. In this study, solar flares (SF), solar proton fluences (SPF), and geomagnetic activity (GMA) were employed as heliogeophysical factors and used Poisson regression and two methods of time series modeling (lag and lead). Influence of GMA in different age and sex category is uneven. The mean number of AMI events per day was greatest (23%) among men aged 25-54years on the third day and the same sex aged 55-64years-increased 10% 2days before when the GMA intensity was A+S. Both for men and women aged ≥65years, the highest increase in the mean number of deaths from IHD events per day was observed on the second day when the GMA intensity was A+S-51 and 34%, respectively. Evaluating the impact of SF of 10(-5)≤SF<10(-4)W/m(2) (M+X) intensity, the mean number of AMI events per day was greatest for 55-64-year-old women and men on the same and second days. Such SF were associated with a 13 and 20% increase, respectively. Evaluating the impact of large fluence SPF, it was determined that the increase in the mean number of AMI events per day among 25-54-year-old men was greatest (30%) 1day, and death from IHD (54%) was observed among women aged ≥65years 2days before the energy of the SPF has increased.

An analytical cross sectional study on psychosocial stressors and psychiatric morbidity in acute myocardial infarction in a tertiary care teaching hospital

An analytical cross sectional study on psychosocial stressors and psychiatric morbidity in acute myocardial infarction in a tertiary care teaching hospital

Data about Natural History of Some Acute Coronary Events at Days of High Cosmic Ray (CRA)-Neutron Activity and Following 48 Hours (2000-2012)

In recent years, many studies were published describing a wide scope of changes related to extreme (stormy) geomagnetic activity. In some countries, prediction of such days is a part of weather prediction information. A number of risk factors like blood coagulation parameters, arterial blood pressure, inflammation markers, and some blood proteins were changing at days of GMA storms. Concomitant studies were published on an inverse phenomenon-increased cardiovascular event at days of Zero GMA, accompanied by high Space Neutron activity on the Earth’s surface—a marker of high Cosmic Ray activity. The aim of this study was to compare two groups of Acute Cardiovascular Events (ACE)—Acute Myocardial Infarction (AMI) and deaths from Ischemic Heart Disease (IHD) at days of extreme Cosmic Ray (CRA)-Neutron activity. Patients & methods: 4749 days at years 2000-2012 were studied considering ACE in a 3000 bed hospital in Kaunas, Lithuania. Cosmophysical data of this period was obtained from USA, Russia, and Finland. ACE was calculated at day of extreme High levels of CRA and following 48 hours. 13629 AMI and 3128 deaths from IHD were included. Results: It was a significant rise in AMI morbidity at day of high CRA (Neutron) activity (≥9300 imp/min). By analysis for each of gender, and patients age groups that were significant difference of AMI for all patients and male >65 y. old at Neutron activity ≥9400 imp/min (p = 0.048; p = 0.03), both gender > 65 y. old at Neutron activity >9500 (p = 0.078) and female >65 y. at Lag 2 (p = 0.07). For deaths from IHD, it was a significant rise at Neutron activity below 9300 imp/min (662 days (13.8%) were above the average of the full observation time-8935 ± 538.083)). Conclusion: At days of high CRA-Neutron activity, it was significantly more AMI. For IHD mortality was higher, but at lower Neutron activity—closer to average Neutron activity and higher GMA.

The Relationship between Serum Hemoglobin and Creatinine Levels and Intra-Hospital Mortality and Morbidity in Acute Myocardial Infarction

Background: Studies have shown that Glomerular Filtration Rate (GFR) and Hemoglobin (Hb) concentrations are two predictive values for ST-elevation Myocardial Infarction (MI) mortality. Objectives: This study aimed to investigate the relationship between GFR and Hb concentrations and intra-hospital mortality and electrocardiographic (ECG) and echocardiographic abnormalities in ST-elevation MI patients admitted to a highly equipped hospital in Mashhad. The results will help define some factors to manage these patients more efficiently. Patients and Methods: This descriptive study aimed to assess the relationship between Hb and GFR concentrations and mortality and morbidity among 294 randomly selected patients with ST-elevation MI. Echocardiography, ECG, and routine laboratory tests, including Hb and creatinine, were performed for all the patients. Then, the data were entered into the SPSS statistical software, version 16 and were analyzed using chi-square, t-test, and ANOVA. P < 0.05 was considered as statistically significant. Results: Intra-hospital mortality rate was 10.5%. Besides, the results showed higher levels of serum blood sugar (P < 0.001), higher levels of creatinine (P < 0.001), lower levels of GFR (P < 0.001), lower ejection fraction (P < 0.001), higher grades of left ventricular diastolic dysfunction (P = 0.002), and lower mean Hb concentration (P = 0.022) in the dead compared to the alive cases. Besides, the patients with mechanical complications had lower Hb levels (P = 0.008). The results showed no significant relationship between creatinine level and mechanical and electrical complications (P = 0.430 and P = 0.095, respectively). However, ejection fraction was significantly associated with GFR (P = 0.016). Conclusions: According to the results, low levels of Hb and GFR could predict mortality caused by ST-elevation MI and ECG abnormalities could notify intra-hospital death. Moreover, lower Hb levels were associated with mechanical complications and could be used as a parameter for diagnosis of high-risk patients.

Meta-Analysis of Carvedilol Versus Beta 1 Selective Beta-Blockers (Atenolol, Bisoprolol, Metoprolol, and Nebivolol)

Because carvedilol is a unique vasodilating β blocker (BB) exerting antioxidant activity and pleiotropic effects, it was theorized that it may confer more potent beneficial effects on cardiovascular mortality and morbidity in acute myocardial infarction (AMI) and heart failure (HF) settings. A systematic review and meta-analysis was performed of randomized, controlled, direct-comparison trials that included adults receiving atenolol, bisoprolol, metoprolol, nebivolol, or carvedilol to evaluate the effects of carvedilol compared to other BBs on mortality, cardiovascular events, and hospital readmissions in the setting of AMI or systolic HF. Compared to β(1)-selective BBs used in HF (8 trials, n = 4,563), carvedilol significantly reduced all-cause mortality (risk ratio 0.85, 95% confidence interval 0.78 to 0.93, p = 0.0006). In 3 trials of patients with AMI (n = 644), carvedilol significantly reduced all-cause mortality by 45% (fixed-effects model: risk ratio 0.55, 95% confidence interval 0.32 to 0.94, p = 0.03, random-effects model: risk ratio 0.56, 95% confidence interval 0.26 to 1.12, p = 0.10), with no reduction in non-fatal MI (risk ratio 0.61, 95% confidence interval 0.31 to 1.22, p = 0.16). In conclusion, carvedilol, as compared against atenolol, bisoprolol, metoprolol and nebivolol in randomized direct comparison trials, significantly reduced all-cause mortality in systolic HF patients. Additionally, carvedilol significantly reduced all-cause mortality compared with β(1)-selective BBs in AMI patients using the fixed-effects model but not using the random-effects model.

The Risk of Acute Myocardial Infarction and Arterial Hypertension in a Cohort of Male Employees of a Siberian Group of Chemical Enterprises Exposed to Long-Term Irradiation

During the period from 1998 to 2007, a prospective cohort study of acute myocardial infarction morbidity cases as well as a "case-control" study of arterial hypertension was carried out. The risk of acute myocardial infarction was assessed as well as arterial hypertension; the dose-response relationship and the role of radiation in the mechanism of acute myocardial infarction as well as arterial hypertension development were studied. As a result of this study, a statistically significant increased risk of acute myocardial infarction among the male staff at the Siberian Group of Chemical Enterprises [standardized relative risk = 1.16 (1.04; 1.29)] exposed to external irradiation in comparison with employees unexposed to ionizing radiation was observed. A significant increase in the risk of acute myocardial infarction was observed at external radiation dose accumulation of more than 300 mSv [standardized relative risk = 1.46 (1.09; 1.91)]. The increase in arterial hypertension risk has been established among the analyzed group of employees exposed to long-term irradiation in the absence of the linear dependence of risk, based on cumulative dose of external γ-irradiation [risk due to external radiation dose in the range of 7.3-21.3 mSv = 1.6 (0.96; 2.51) and in the range of external radiation dose 21.4-68.5 mSv = 1.7 (1.04; 2.67) for 68.6-864 mSv = 1.6 (1.01; 2.57)]. This led to the conclusion that radiation can act also as a factor that might potentiate the negative effects of the "traditional" risk factors in the pathogenesis of acute myocardial infarction and hypertension.

Incidence and 30-day case fatality for acute myocardial infarction in England in 2010: national-linked database study

Background: There are limited national population-based epidemiological data on acute myocardial infarction (AMI) in England, making the current burden of disease, and clinical prognosis, difficult to quantify. The aim of this study was to provide national estimates of incidence and 30-day case fatality rate (CFR) for first and recurrent AMI in England. Methods: Population-based study using person-linked routine hospital and mortality data on 79 896 individuals of any age, who were admitted to hospital for AMI or who died suddenly from AMI in 2010. Results: Of 82 252 AMI events in 2010, 83% were first. Age-standardized incidence of first AMI per 100 000 population was 130 (95% CI 129–131) in men and 55.9 (95% CI 55.3–56.6) in women. Age-standardized 30-day overall CFRs including sudden AMI deaths for men and women, respectively, were 32.4% (95% CI 32.0–32.9) and 30.3% (95% CI 29.8–30.9) for first AMI and 29.7% (95% CI 28.7–30.7) and 26.7% (95% CI 25.5–27.9) for recurrent AMI. Age-standardized hospitalized 30-day CFR was 12.0% (95% CI 11.6–12.3) for men and 12.3% (95% CI 11.9–12.7) for women. Conclusions: While the majority of AMIs are not fatal, of those that are, two-thirds occur as sudden AMI deaths. About one in six of all AMIs are recurrent events. These findings reinforce the importance of primary and secondary prevention in reducing AMI morbidity and mortality.

Antiplatelet therapies for the treatment of cardiovascular disease

Antiplatelet therapy has been successful in reducing mortality and morbidity in acute myocardial infarction. Recent advances in understanding the molecular basis of the role of platelets in cardiovascular thrombosis have enabled the development of new agents with the potential to further reduce mortality and morbidity. This article reviews the role of platelets in haemostasis and cardiovascular thrombosis, and discusses the benefits and limitations of current and investigational antiplatelet agents in the treatment of cardiovascular disease.

Valoración de la Ley 28/2005 de medidas sanitarias frente al tabaquismo

The implementation in 2006 of the law 28/2006 for smoking prevention was a milestone for modern public health in Spain. This law regulated three aspects: it banned the direct and indirect tobacco publicity and sponsorship, it reduced points of sale, and it banned smoking in enclosed workplaces and public spaces, with exemptions concentrating in the restaurant and hospitality sector. As it was implemented, other changes with preventive capacity were adopted: taxes on cigarettes were raised, and there were more resources for prevention and treatment, besides information campaigns and an intensive social debate on smoking. To evaluate the isolated effect of the law is complex, but in this paper we make an attempt by reviewing all the available information, despite its heterogeneity. More than three years after its implementation there are elements suggesting a positive impact on smoking prevalence among teens, in the general consumption of cigarettes and in acute myocardial infarction morbidity. Public policies are important for smoking prevention and to improve population s health, as they create a context conducive to smoking cessation. To reach further progress in smoking prevention in Spain, the current exemption for bars and restaurants in the smoking ban should be removed, and the taxation of tobacco products should be increased.