Impact of COVID-19 endemicity on the landscape of myocardial infarction and risk factors from 2025 to 2040: A population-based forecast

As COVID-19 transitions to endemicity, its adverse impact on acute myocardial infarction (AMI) will evolve in the post-pandemic decades. Our study examines the excess AMI mortality contributed by COVID-19 via projection into the endemic era from 2025 to 2040. Data from the Singapore Myocardial Infarction Registry (SMIR) were used to construct Poisson regression models to forecast AMI mortality from 2025 to 2040, based on COVID-free and post-COVID historical data. COVID-free and post-COVID forecasts were compared to examine the excess AMI mortality contributed by COVID-19. This was further stratified by sex, age group, AMI type and cardiovascular risk factors. From 2025 to 2040, pre-pandemic improvement in AMI mortality (compound annual growth rate [CAGR] -1.6%) is expected to plateau (CAGR -0.9%) in post-COVID projections, compared to COVID-free projections (CAGR -2.3%). Older adults and middle-aged adults will experience slower improvement in AMI mortality in post-COVID projections compared to COVID-free projections. ST-elevation myocardial infarction-related mortality are projected to increase based on post-COVID projections, versus a decline in COVID-free predictions. Improvements in AMI mortality in individuals with T2D and hypertension will slow, while improvements in AMI mortality in individuals with hyperlipidaemia and overweight/obesity will reverse in the endemic era. As COVID-19 transitions to endemicity, decades-long AMI mortality improvement is expected to plateau, driven by worsening hypertension, hyperlipidemia, T2D and obesity.