Epidemiology
Epidemiological trends in acute coronary syndromes: understanding the past to predict and improve the future

Epidemiology of acute coronary syndrome is of major public health interest as coronary disease is the leading cause of morbidity and mortality worldwide. There are dynamic changes in the prevalence of coronary risk factors and clinically manifest coronary heart disease (CHD) across geographically-diverse communities. Decreases in cigarette smoking, cholesterol and blood pressure are counterbalanced by increases in proportion of the elderly population and absolute increases in obesity and diabetes. Additionally, interpretation of changes in this epidemiology is complicated by changes in the definition of myocardial infarction and changes in the sensitivity of biomarker assays. Nevertheless, improvements in evidence-based treatment have resulted in declining case-fatality. The reduction in event-rates has contributed to more than half of the reduction in CHD mortality and reduction in case-fatality accounted for the remainder. Despite these changes in developed economies, mortality is increasing elsewhere and CHD is likely to remain the biggest killer globally in coming years.