ESC Congress 2026 Abstract · Oct 26, 2026
Region of birth and risk for a first myocardial infarction in Sweden, 1992-2021
By Arampampaslis A, Herlitz S, Jernberg T et al.
Introduction: Cardiovascular disease remains the leading cause of death globally and myocardial infarction (MI) persists as a substantial disease burden. Due to migration, Sweden’s demographic landscape has changed drastically over recent decades. However, contemporary data on the association between region of birth and MI risk is lacking. Purpose: To investigate the association between region of birth and the risk of a first-time myocardial infarction (MI) in Sweden, 1992-2021. Additionally, temporal trends were examined, and clinical risk profiles were assessed. Methods: A nationwide register-based matched case-control study was conducted for the 30-year period using the SWEDEHEART register linked with Statistics Sweden to obtain data on socioeconomic status (SES), region of birth and controls. For each case of first-time MI five population-based controls were matched for age, sex and county of residence. The exposure variable, region of birth, was categorized into nine geographical regions. Temporal trends were analyzed by dividing the study period into six five-year blocks. Multivariable logistic regression models were used to estimate odds ratios (ORs) with 95% confidence intervals (CIs) for the association between region of birth and MI, adjusting for SES measured by income and educational level. Results: In total, 329 609 cases and 1 645 993 controls, mean age 70.3 and 37.0% female, were included. Compared with Swedish-born individuals, the crude risk for MI was higher among those born in Asia (OR 1.68, 95% CI 1.64-1.72) and Eastern Europe (OR 1.45, 95% CI 1.41-1.48). After adjusting for SES, odds for a first MI remained higher for individuals born in Asia (OR 1.42, 95% CI 1.38-1.46) and Eastern Europe (OR 1.28, 95% CI 1.25-1.31). Conversely, a lower risk was observed among individuals born in South America (OR 0.73, 95% CI 0.68-0.79). Trend analyses showed stable relative risk over the 30-year period across all regions, but the proportion of MI cases from high-risk regions increased substantially, with cases from Asia rising from 0.8% (1992-1996) to 5.8% (2017-2021). When analyzing risk profiles, it was noted that MI patients born in Asia and Africa were significantly younger at disease onset (mean age 58.8 and 58.1 years respectively) vs Swedish-born cases (mean age 71.0). These groups also presented with a higher prevalence of diabetes (Asia: 27.5% and Africa: 34.4%) versus 17.1% in Swedish-born patients. Furthermore, Asian-born individuals had the lowest HDL-cholesterol and highest triglyceride levels of all regions. Conclusions: Region of birth was associated with MI, independent of age, sex, county of residence, and SES. The growing proportion of MIs among high-risk immigrant groups with adverse clinical risk profiles highlights an urgent need for targeted preventive strategies.Cases by region and time periodClinical risk profiles of cases