Impact of Smoking Reduction Scenarios on the Burden of Myocardial Infarction in the French Population Until 2035

Johann Kuhn,1 Valérie Olié,2 Clémence Grave,2 Yann Le Strat,1 Christophe Bonaldi,1 Pierre Joly1,3 1Data Science Division, French National Public Health Agency, Saint-Maurice, France; 2Department of Chronic Diseases and Injuries, French National Public Health Agency, Saint-Maurice, France; 3Centre Inserm U1219 – Bordeaux Population Health, Université de Bordeaux – ISPED, Bordeaux, FranceCorrespondence: Johann Kuhn, Email [email protected]: Myocardial infarction (MI) is a cardiovascular disease caused by necrosis of the myocardium, which places a heavy burden on patients. In France, the proportion of daily smokers remains high, reaching at 25.5% in 2020. We evaluated the impact of smoking reduction scenarios on the projection of MI prevalence, mean age of incident cases and number of MI prevented cases until 2035.Methods and Results: The French government has introduced smoking cessation policies that have led to an annual decrease in smoking prevalence. Based on this annual decline, we implemented three scenarios (SC) simulating an annual decrease in the proportion of smokers aged over 35 (SC1: 1%, ie, natural evolution without intervention, SC2: 2%, SC3: 9.87%) and a fourth scenario (SC4) in which there is a complete discontinuation of smoking from 2024 onwards using MI hospitalization and demographic data, estimations for the proportion of daily smokers between 35 and 95 years and multi-state models. Between 2023 and 2035, MI prevalence increased from 3.18% to 4.23% in males and from 1.00% to 1.46% in females under SC1. MI prevalence was equal to 4.21%, 4.06%, and 3.82% in males and 1.45%, 1.40%, and 1.34% in females in 2035 according to SC2, SC3, and SC4, respectively. Compared with SC1, 0.68% MI cases would be prevented with SC2, 4.52% with SC3 and 10.34% with SC4, with almost half of cases being prevented before 65 years of age. The increase in the mean age of MI incident cases ranged from 3 to 4 years among males and from 1 to 2 years among females.Conclusion: While reducing tobacco use could substantially reduce the number of MI cases prevented, its prevalence would continue to increase due to the ageing population. An integrated prevention strategy that includes the leading cardiovascular risk factors should more efficiently reduce the future burden of MI.Keywords: myocardial infarction, prevalence, burden, projection, tobacco control, smoking prevalence