Rates of acute myocardial infarction (AMI) have held steady over the past decades in the United States even though the prevalence of coronary heart disease has declined. Therefore, the incidence and survival rates of initial AMI diagnosis by ECG (AMI-ECG) and those based on infarction biomarkers (AMI-markers) were compared over 4 decades (1960 to 1969, 1970 to 1979, 1980 to 1989 and 1990 to 1999) in participants of the Framingham Heart Study. Overall, 941 first AMIs occurred (68% AMI-ECG and 32% AMI-markers). Rates of AMI-ECG declined by approximately 50% while rates of AMI-markers doubled over the study period. However, 5-year case fatality rates after overall AMI decreased steadily from 1960 to 1999 (p<0.001). Similar results were obtained when AMI-ECG and AMI-markers were examined separately. Moreover, similar decreases were observed in 30-day and 1-year case fatality rates after overall AMI, AMI-ECG and AMI-markers, with a particular shift seen between 1970 and 1980. These results may explain why AMI rates did not change over several decades in the United States. In his editorial, Dr. Robert J. Goldberg recognized that the Framingham Heart Study has again been proven to be a remarkable resource for the study of coronary disease and its antecedents as well as a fertile source of data for clinical and epidemiological researchers. He also underlined that the information provided by epidemiological prospective studies is of critical importance in order to continue our quest for better identification of patients at increased risk of coronary heart disease, less-than-optimal use of effective cardiac therapies and unsatisfactory short- and long-term patient outcomes. This is particularly important given recent increases in the prevalence of several major cardiovascular disease risk factors such as type 2 diabetes and obesity.
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