Lifetime risk of cardiomyopathy in the general population: a nationwide cohort study from Sweden
E Linner, E Bollano, P Eldhagen, A Mokhtari, K Konstantinou, J Lundgren, H Palmefors, H Isackson, J Faxen, O Gidlof, A Rosengren, A Pivodic, O Braun, B Pilebro, G SmithAbstract
Background
Cardiomyopathies are a heterogeneous group of myocardial disorders associated with heart failure, arrhythmias, heart transplantation, and sudden cardiac death, often affecting individuals without traditional cardiovascular risk factors. Although recent advances in imaging, genetics, and registry data suggest that cardiomyopathies may be more common than previously recognised, robust population-based estimates of lifetime risk are lacking. In addition, temporal trends in incidence remain uncertain, and contemporary data on premature mortality and life expectancy following diagnosis are limited.
Purpose
To estimate the lifetime risk and life-years lost due to cardiomyopathies in the Swedish population and assess temporal trends in incidence.
Methods
We conducted a nationwide, registry-based cohort study including all individuals born in 1922 and later, residing in Sweden between 2003 and 2023. Cardiomyopathy diagnoses were identified from nationwide registers using validated algorithms. Lifetime risk was estimated using competing risk models while incidence trends were assessed from age-standardised rates and joinpoint regression.
Results
Among 13.6 million individuals, 58,735 received a cardiomyopathy diagnosis. The lifetime risk was 2.50% (95%CI=2.48-2.52) overall, and 50% higher in men. Lifetime risk was 1.21% (95%CI=1.20-1.22) for dilated cardiomyopathy (DCM), 0.62% (95%CI=0.61-0.63) for hypertrophic cardiomyopathy (HCM), and 0.03% (95%CI=0.03-0.03) for restrictive cardiomyopathy (RCM). On average, 8.7 life-years were lost to cardiomyopathy, highest for RCM (12.2 years), 9.5 years for DCM, and lowest for HCM (6.8 years). The age-adjusted incidence of HCM increased 80% over time, while DCM and RCM remained stable. Rising incidence was most pronounced in older age groups.
Conclusions
In this nationwide study, the lifetime risk of cardiomyopathy was 2.5% in adults, half of which represented DCM, and markedly higher in men. Life-years lost were highest for RCM and lowest for HCM. Temporal trends suggest a rising burden of HCM. These findings highlight the need for targeted prevention, early detection strategies, and further research into underlying drivers.Life time risk of incident cardiomyopathyTemporal trends cardiomyopathy incidence