Urbanization, Life Style Changes and the Incidence/In-Hospital Mortality of Acute Myocardial Infarction in Japan - Report From the MIYAGI-AMI Registry Study

Background: It remains to be examined whether urbanization and lifestyle changes are associated with the incidence and mortality from acute myocardial infarction (AMI) in Japan. Methods and Results: A total of 19,921 AMI patients (male/female 14,290/5,631) registered by the MIYAGI-AMI Registry Study from 1988 to 2009 were divided into 2 groups according to their residences; inside (urban area, n=7,316) and outside (rural area, n=11,402) of Sendai City. From 1988 to 2009, the incidence of AMI (/100,000 persons/year) increased more rapidly in the rural area (24.2 to 51.4) than in the urban area (31.3 to 40.8) (P<0.001), with rapid aging in both areas. Moreover, from 1998 to 2009, the age-adjusted incidence of AMI in young (<44 years) and middle-aged (45-64 years) male patients (both P<0.05) in the rural area increased significantly, along with a markedly increased prevalence of dyslipidemia (P<0.001). Although in-hospital mortality from AMI decreased in both areas over the last 20 years (both P<0.001), it remained relatively higher in female than in male patients and was associated with higher age of the onset, longer elapsing time for admission and lower prevalence of primary coronary intervention in female patients in both areas. Conclusions: These results demonstrate that urbanization and lifestyle changes have been associated with the incidence and mortality from AMI, although sex differences still remain to be improved. (Circ J 2012; 76:1136-1144)