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An analysis of nationwide data in Singapore suggests obesity is set to become the leading metabolic risk factor underlying acute myocardial infarction onset, overtaking hypertension and hyperlipidemia in the coming decades.
New data from a multiethnic nationwide cohort study suggests the incidence of acute myocardial infarction (AMI) is projected to rise nearly 3-fold in the coming decades, with obesity projected to be the main metabolic risk factor driving onset and related deaths.1
The analysis, based in Singapore, predicted 4 in 1,000 citizens will have an AMI event in 2025; by 2050, the forecast analysis based on the growing metabolic burden projects 1 in 100 Singaporeans will experience an AMI event.
“We have to move away from a ‘one-size-fits-all’ approach to address challenges faced by groups at risk of AMI-onset and mortality,” Nicholas Chew, MD, lead study author from the Cardiovascular-Metabolic Disease Translational Research Program (CVMD TRP) at the Yong Loo Lin school of medicine at the National University of Singapore, said in a statement.2 “For example, the rise in obesity as a risk factor for metabolic disease morbidity is more predominant in younger and middle-aged groups, whereas metabolic disease mortality for older populations is driven by hypertension and hyperlipidemia. This necessitates differentiated interventions.”
There is well-established evidence that the development of cardiovascular disease (CVD) is influenced by various metabolic risk factors, including type 2 diabetes (T2D), hypertension, hyperlipidemia, overweight/obesity, and cigarette smoking. Despite prior studies exploring the metabolic burden among individuals with AMI, there is limited research on the projected trends and patterns of metabolic diseases in these patients within the coming decades. Based on patients captured in the Singapore Myocardial Infarction Registry (SMIR) from January 2007 - December 2018, the current study aimed to forecast trends of metabolic diseases in the population with AMI.
The SMIR is a national registry of all patients diagnosed with AMI who present at both public and private hospitals in Singapore. AMI cases are identified from hospital discharge records, reimbursement claims, and the national death registry. Using these data, the investigative team projected the incidence and AMI-related mortality of each metabolic disease from 2025 to 2050 and stratified by age group, sex, and ethnicity, using linear and Poisson regression models.
Upon analysis, the incidence of AMI is predicted to rise by 194.4% from 2025 to 2050, from 482 to 1418 per 100,000 population. The analysis predicts the incidence to increase in males by 211.9% and in females by 169.5%, while the Malay population in Singapore is predicted to have the highest AMI incidence from 2025 to 2050 (216.4% increase). Overweight and obesity are additionally predicted to remain the most prevalent risk factor underlying AMI in all age groups by 2050, with the largest increase projected to occur in those aged ≥65 years.
Regarding metabolic risk factors, the largest percentage increase in patients with AMI is projected to be overweight/obesity (880.0% increase), followed by hypertension (248.7% increase), T2D (215.7% increase), hyperlipidemia (205.0%), and active/previous smoking (164.8% increase). Moreover, from 2025 to 2050, the total 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 T2D, and 49.6% in active/previous smokers.
A disproportionately larger increase in AMI incidence is expected in females who are overweight or obese, with a 1204.7% increase in the cohort by 2050, while men are expected to see only a 791.5% increase. A higher incidence of patients with AMI who are overweight/obese is expected among the Malay population (1191.9%) between 2025 and 2050. In addition, the largest rise in AMI-related mortality is predicted in the Malay population (419.3%).
The investigative team suggested these new epidemiological insights garnered from the population-based analysis could potentially inform global response to cardiovascular-metabolic diseases.
“There are many European and US-based studies that have explored the cardiovascular disease trajectories in predominantly Western populations,” Mark Chan, deputy director of the CVMD TRP at the National University of Singapore said in a statement.2 “However, few studies forecast trends that are representative of an increasingly multi-ethnic Asia. The trends identified in this study is a good representation of larger, emerging trends in rapidly-growing Asia societies due to Singapore’s rapid rate of socioeconomic development and our multi-ethnic case mix.”