Chronic stable angina epidemiology and demographics: Difference between revisions

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{{Chronic stable angina}}
{{Chronic stable angina}}
{{CMG}}; '''Associate Editor-In-Chief:''' [[Varun Kumar]], M.B.B.S.
{{CMG}}; '''Associate Editor-In-Chief:''' [[Varun Kumar|Varun Kumar, M.B.B.S.]]


==Overview==
==Overview==
[[Coronary artery disease]] ([[CAD]]) remains the single leading cause of death in the United States, and stable angina is the initial manifestation of [[ischemic heart disease]] in approximately 50% of these patients.
[[Coronary artery disease|Coronary artery disease (CAD)]] remains the single leading cause of death in the United States. Stable angina is the initial manifestation of [[ischemic heart disease]] in approximately 50% of these patients.


==Developed countries==
==Epidemiology and Demographics==
Coronary artery disease (CAD) remains the single leading cause of death in the United States.  In Europe, [[CAD]] accounts for 49% of all deaths. Stable angina is the initial manifestation of ischemic heart disease in approximately 50% of these patients.
===Age===
* Age is one of the independent risk factors for [[coronary heart disease]].
* The prevalence of [[CHD]] increases with age.
* According to the [[Framingham Heart Study]], the lifetime risk of developing [[CHD]] at the age of 40 is 49% in men and 32% in women while the risk at 75 years of age is 35% in men and 24% in women.<ref name="pmid677576">{{cite journal| author=Gordon T, Kannel WB, Hjortland MC, McNamara PM| title=Menopause and coronary heart disease. The Framingham Study. | journal=Ann Intern Med | year= 1978 | volume= 89 | issue= 2 | pages= 157-61 | pmid=677576 | doi= | pmc= | url= }} </ref><ref name="pmid3946178">{{cite journal| author=Lerner DJ, Kannel WB| title=Patterns of coronary heart disease morbidity and mortality in the sexes: a 26-year follow-up of the Framingham population. | journal=Am Heart J | year= 1986 | volume= 111 | issue= 2 | pages= 383-90 | pmid=3946178 | doi= | pmc= | url= }} </ref>


2010 statistics released by the American Heart Association indicate that approximately '''10.2 million''' people in United States suffer from angina pectoris<ref name="pmid20177011">{{cite journal| author=Lloyd-Jones D, Adams RJ, Brown TM, Carnethon M, Dai S, De Simone G et al.| title=Executive summary: heart disease and stroke statistics--2010 update: a report from the American Heart Association. | journal=Circulation | year= 2010 | volume= 121 | issue= 7 | pages= 948-54 | pmid=20177011 | doi=10.1161/CIRCULATIONAHA.109.192666 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20177011  }} </ref>. In 2007 the overall death rate from coronary artery disease was '''251.2 per 100,000''' people, and coronary artery disease accounted for 33.6% of total deaths from all causes.
===Gender===
* The onset of [[coronary artery disease]] in women follows that of men by about 10 years.
* The incidence of CAD is greater in males when compared to [[premenopausal]] women. However, the incidence increases in [[postmenopausal]] women.<ref name="pmid677576">{{cite journal| author=Gordon T, Kannel WB, Hjortland MC, McNamara PM| title=Menopause and coronary heart disease. The Framingham Study. | journal=Ann Intern Med | year= 1978 | volume= 89 | issue= 2 | pages= 157-61 | pmid=677576 | doi= | pmc= | url= }} </ref>
* During 26 years of follow-up in the [[Framingham Heart Study]], 80% of women under 75 years of age presented with [[angina pectoris]] rather than [[myocardial infarction]]. In contrast, only 20% of men presented with [[angina pectoris]] as their first manifestation of [[coronary artery disease]].<ref name="pmid3493089">{{cite journal| author=Kannel WB| title=Prevalence and clinical aspects of unrecognized myocardial infarction and sudden unexpected death. | journal=Circulation | year= 1987 | volume= 75 | issue= 3 Pt 2 | pages= II4-5 | pmid=3493089 | doi= | pmc= | url= }} </ref>


Though the death rate from coronary artery disease decreased by '''27.8%''' from 1997 to 2007, the over all burden of the disease remains high secondary to high prevalence of risk factors such as [[smoking]], [[hypertension]], [[diabetes]] and [[obesity]]<ref name="pmid6702862">{{cite journal| author=Castelli WP| title=Epidemiology of coronary heart disease: the Framingham study. | journal=Am J Med | year= 1984 | volume= 76 | issue= 2A | pages= 4-12 | pmid=6702862 | doi= | pmc= | url= }} </ref>.  In 2008, an estimated 18.3 million Americans were diagnosed with [[diabetes mellitus]], accounting for approximately 8.0% of the adult population. Serum [[cholesterol]] levels of ≥240 mg/dL were observed in approximately '''33.6 million''' adults ≥20 years of age<ref name="pmid21160056">{{cite journal| author=Roger VL, Go AS, Lloyd-Jones DM, Adams RJ, Berry JD, Brown TM et al.| title=Heart disease and stroke statistics--2011 update: a report from the American Heart Association. | journal=Circulation | year= 2011 | volume= 123 | issue= 4 | pages= e18-e209 | pmid=21160056 | doi=10.1161/CIR.0b013e3182009701 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21160056  }} </ref>.  
===Developed Countries===
*Coronary artery disease (CAD) remains the single leading cause of death in the United States.
* In Europe, CAD accounts for 49% of all deaths.  Stable angina is the initial manifestation of ischemic heart disease in approximately 50% of these patients.
* 2010 statistics released by the American Heart Association indicate that approximately 10.2 million people in United States suffer from angina pectoris.<ref name="pmid20177011">{{cite journal| author=Lloyd-Jones D, Adams RJ, Brown TM, Carnethon M, Dai S, De Simone G et al.| title=Executive summary: heart disease and stroke statistics--2010 update: a report from the American Heart Association. | journal=Circulation | year= 2010 | volume= 121 | issue= 7 | pages= 948-54 | pmid=20177011 | doi=10.1161/CIRCULATIONAHA.109.192666 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20177011  }} </ref>
*In 2007 the overall death rate from coronary artery disease was 251.2 per 100,000 people, and coronary artery disease accounted for 33.6% of total deaths from all causes.
* Though the death rate from coronary artery disease decreased by 27.8% from 1997 to 2007, the over all burden of the disease remains high secondary to high prevalence of risk factors such as [[smoking]], [[hypertension]], [[diabetes]] and [[obesity]].<ref name="pmid6702862">{{cite journal| author=Castelli WP| title=Epidemiology of coronary heart disease: the Framingham study. | journal=Am J Med | year= 1984 | volume= 76 | issue= 2A | pages= 4-12 | pmid=6702862 | doi= | pmc= | url= }} </ref>
* In 2008, an estimated 18.3 million Americans were diagnosed with [[diabetes mellitus]], accounting for approximately 8.0% of the adult population. Serum [[cholesterol]] levels of ≥240 mg/dL were observed in approximately 33.6 million adults ≥20 years of age.<ref name="pmid21160056">{{cite journal| author=Roger VL, Go AS, Lloyd-Jones DM, Adams RJ, Berry JD, Brown TM et al.| title=Heart disease and stroke statistics--2011 update: a report from the American Heart Association. | journal=Circulation | year= 2011 | volume= 123 | issue= 4 | pages= e18-e209 | pmid=21160056 | doi=10.1161/CIR.0b013e3182009701 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21160056  }} </ref>
* The incidence of CAD in France is low despite the consumption of fat rich food. This is termed [[french paradox|French Paradox]] and is partly explained by greater intake of alcohol which supposedly improves serum [[HDL]] levels.<ref name="pmid9457446">{{cite journal| author=Constant J| title=Alcohol, ischemic heart disease, and the French paradox. | journal=Coron Artery Dis | year= 1997 | volume= 8 | issue= 10 | pages= 645-9 | pmid=9457446 | doi= | pmc= | url= }} </ref>
* People in the Mediterranean region and Eskimos have a lower incidence of [[coronary artery disease]] due to higher consumption of [[canola oil]] and [[fish oil]], respectively. These diet items contain [[omega-3 fatty acids]] that are less atherogenic.


The incidence of [[CAD]] in France is low despite the consumption of fat rich food. This is termed '''[[french paradox|French Paradox]]''' and is partly explained by greater intake of alcohol which supposedly improves serum [[HDL]] levels<ref name="pmid9457446">{{cite journal| author=Constant J| title=Alcohol, ischemic heart disease, and the French paradox. | journal=Coron Artery Dis | year= 1997 | volume= 8 | issue= 10 | pages= 645-9 | pmid=9457446 | doi= | pmc= | url= }} </ref>.
===Developing Countries===
 
* In the past, the incidence and prevalence of [[coronary artery disease]] were low in developing countries in comparison to developed countries. But with the westernization of developing regions in Middle East, India, and Central and South America, the incidence of CAD is increasing.<ref name="pmid16291069">Srinath Reddy K, Shah B, Varghese C, Ramadoss A (2005) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=16291069 Responding to the threat of chronic diseases in India.] ''Lancet'' 366 (9498):1744-9. [http://dx.doi.org/10.1016/S0140-6736(05)67343-6 DOI:10.1016/S0140-6736(05)67343-6] PMID: [http://pubmed.gov/16291069 16291069]</ref>
People in Mediterranean region and Eskimos have a lower incidence of [[coronary artery disease]] due to higher consumption of [[canola oil]] and [[fish oil]] respectively which contain [[omega-3 fatty acids]] that are less [[atherogenic]].
* The prevalence of [[coronary artery disease]] among adults in India has risen 4-fold over the last 40 years. By the year 2005, it was the leading cause of death accounting for 29% of the total deaths from all causes.<ref name="pmid16291069">{{cite journal| author=Srinath Reddy K, Shah B, Varghese C, Ramadoss A| title=Responding to the threat of chronic diseases in India. | journal=Lancet | year= 2005 | volume= 366 | issue= 9498 | pages= 1744-9 | pmid=16291069 | doi=10.1016/S0140-6736(05)67343-6 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16291069  }} </ref>
 
* In the year 2000, it was estimated that 9.2 million potentially productive years of life were lost due to deaths secondary to [[CAD]] in the age group of 35 to 64 years and that number is expected to rise to a loss of 17.9 million years by the year 2030 which is 940% more than the projected figure for the U.S.<ref> Leeder S, Raymond S, Greenberg H, Liu H, Esson K. A Race Against TimeThe Challenge of Cardiovascular Disease in Developing Countries. New York, NY: Columbia University; 2005.</ref>
==Developing countries==
* The prevalence of CAD has been increasing in China with increase in risk factors such as [[smoking]] and mean [[cholesterol]] levels which have increased from 166 mg/dL to 206 mg/dL over the past 15 years.<ref name="pmid15337690">{{cite journal| author=Critchley J, Liu J, Zhao D, Wei W, Capewell S| title=Explaining the increase in coronary heart disease mortality in Beijing between 1984 and 1999. | journal=Circulation | year= 2004 | volume= 110 | issue= 10 | pages= 1236-44 | pmid=15337690 | doi=10.1161/01.CIR.0000140668.91896.AE | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15337690  }} </ref>
In the past, the incidence and prevalence of [[coronary artery disease]] were low in developing countries in comparison to developed countries. But with the westernization of developing regions in Middle East, India, and Central and South America, the incidence of [[CAD]] is increasing<ref name="pmid16291069">Srinath Reddy K, Shah B, Varghese C, Ramadoss A (2005) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=16291069 Responding to the threat of chronic diseases in India.] ''Lancet'' 366 (9498):1744-9. [http://dx.doi.org/10.1016/S0140-6736(05)67343-6 DOI:10.1016/S0140-6736(05)67343-6] PMID: [http://pubmed.gov/16291069 16291069]</ref>.
 
The prevalence of [[coronary artery disease]] among adults in India has risen '''4-fold over the last 40 years'''. By the year 2005, it was the leading cause of death accounting for 29% of the total deaths from all causes<ref name="pmid16291069">{{cite journal| author=Srinath Reddy K, Shah B, Varghese C, Ramadoss A| title=Responding to the threat of chronic diseases in India. | journal=Lancet | year= 2005 | volume= 366 | issue= 9498 | pages= 1744-9 | pmid=16291069 | doi=10.1016/S0140-6736(05)67343-6 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16291069  }} </ref>.  In the year 2000, it was estimated that 9.2 million potentially productive years of life were lost due to deaths secondary to [[CAD]] in the age group of 35 to 64 years and that number is expected to rise to a loss of 17.9 million years by the year 2030 which is 940% more than the projected figure for the U.S.<ref> Leeder S, Raymond S, Greenberg H, Liu H, Esson K. A Race Against TimeThe Challenge of Cardiovascular Disease in Developing Countries. New York, NY: Columbia University; 2005.</ref>.
 
The prevalence of [[CAD]] has been increasing in China with increase in risk factors such as [[smoking]] and mean [[cholesterol]] levels which have increased from '''166 mg/dL to 206 mg/dL over the past 15 years'''<ref name="pmid15337690">{{cite journal| author=Critchley J, Liu J, Zhao D, Wei W, Capewell S| title=Explaining the increase in coronary heart disease mortality in Beijing between 1984 and 1999. | journal=Circulation | year= 2004 | volume= 110 | issue= 10 | pages= 1236-44 | pmid=15337690 | doi=10.1161/01.CIR.0000140668.91896.AE | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15337690  }} </ref>.
 
==Age==
Age is one of the independent risk factors for [[coronary heart disease]]. The '''prevalence of [[CHD]] increase with age'''. According to the '''[[Framingham heart study]]''', the lifetime risk of developing [[CHD]] at the age of 40 is 49% in men and 32% in women while the risk at 75 years of age is 35% in men and 24% in women<ref name="pmid677576">{{cite journal| author=Gordon T, Kannel WB, Hjortland MC, McNamara PM| title=Menopause and coronary heart disease. The Framingham Study. | journal=Ann Intern Med | year= 1978 | volume= 89 | issue= 2 | pages= 157-61 | pmid=677576 | doi= | pmc= | url= }} </ref><ref name="pmid3946178">{{cite journal| author=Lerner DJ, Kannel WB| title=Patterns of coronary heart disease morbidity and mortality in the sexes: a 26-year follow-up of the Framingham population. | journal=Am Heart J | year= 1986 | volume= 111 | issue= 2 | pages= 383-90 | pmid=3946178 | doi= | pmc= | url= }} </ref>.
 
==The Impact of Gender==
The incidence of [[CHD]] is greater in males when compared to [[premenopausal]] women.  However, the incidence increases in [[postmenopausal]] women<ref name="pmid677576">{{cite journal| author=Gordon T, Kannel WB, Hjortland MC, McNamara PM| title=Menopause and coronary heart disease. The Framingham Study. | journal=Ann Intern Med | year= 1978 | volume= 89 | issue= 2 | pages= 157-61 | pmid=677576 | doi= | pmc= | url= }} </ref>. They follow men by 10 years, especially after [[menopause]]. In a series, it was concluded that the incidence of [[angina pectoris]] among women was similar to that for men. Furthermore, [[stable angina]] in women was associated with increased coronary mortality relative to women in the general population and, among easily identifiable clinical
subgroups, has similarly high absolute rates of prognostic outcomes compared with men<ref name="pmid16551712">{{cite journal| author=Hemingway H, McCallum A, Shipley M, Manderbacka K, Martikainen P, Keskimäki I| title=Incidence and prognostic implications of stable angina pectoris among women and men. | journal=JAMA | year= 2006 | volume= 295 | issue= 12 | pages= 1404-11 | pmid=16551712 | doi=10.1001/jama.295.12.1404 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16551712  }} </ref>.
 
During 26year follow-up in [[Framingham heart study]], it was observed that 80% of women under 75year of age most likely presented with ''' uncomplicated [[angina pectoris]]''' than [[myocardial infraction]]. While only 20% of men presented with angina as their first manifestation of coronary artery disease<ref name="pmid3493089">{{cite journal| author=Kannel WB| title=Prevalence and clinical aspects of unrecognized myocardial infarction and sudden unexpected death. | journal=Circulation | year= 1987 | volume= 75 | issue= 3 Pt 2 | pages= II4-5 | pmid=3493089 | doi= | pmc= | url= }} </ref>.


==References==
==References==
{{Reflist|2}}
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Latest revision as of 16:43, 6 February 2013

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor-In-Chief: Varun Kumar, M.B.B.S.

Overview

Coronary artery disease (CAD) remains the single leading cause of death in the United States. Stable angina is the initial manifestation of ischemic heart disease in approximately 50% of these patients.

Epidemiology and Demographics

Age

  • Age is one of the independent risk factors for coronary heart disease.
  • The prevalence of CHD increases with age.
  • According to the Framingham Heart Study, the lifetime risk of developing CHD at the age of 40 is 49% in men and 32% in women while the risk at 75 years of age is 35% in men and 24% in women.[1][2]

Gender

Developed Countries

  • Coronary artery disease (CAD) remains the single leading cause of death in the United States.
  • In Europe, CAD accounts for 49% of all deaths. Stable angina is the initial manifestation of ischemic heart disease in approximately 50% of these patients.
  • 2010 statistics released by the American Heart Association indicate that approximately 10.2 million people in United States suffer from angina pectoris.[4]
  • In 2007 the overall death rate from coronary artery disease was 251.2 per 100,000 people, and coronary artery disease accounted for 33.6% of total deaths from all causes.
  • Though the death rate from coronary artery disease decreased by 27.8% from 1997 to 2007, the over all burden of the disease remains high secondary to high prevalence of risk factors such as smoking, hypertension, diabetes and obesity.[5]
  • In 2008, an estimated 18.3 million Americans were diagnosed with diabetes mellitus, accounting for approximately 8.0% of the adult population. Serum cholesterol levels of ≥240 mg/dL were observed in approximately 33.6 million adults ≥20 years of age.[6]
  • The incidence of CAD in France is low despite the consumption of fat rich food. This is termed French Paradox and is partly explained by greater intake of alcohol which supposedly improves serum HDL levels.[7]
  • People in the Mediterranean region and Eskimos have a lower incidence of coronary artery disease due to higher consumption of canola oil and fish oil, respectively. These diet items contain omega-3 fatty acids that are less atherogenic.

Developing Countries

  • In the past, the incidence and prevalence of coronary artery disease were low in developing countries in comparison to developed countries. But with the westernization of developing regions in Middle East, India, and Central and South America, the incidence of CAD is increasing.[8]
  • The prevalence of coronary artery disease among adults in India has risen 4-fold over the last 40 years. By the year 2005, it was the leading cause of death accounting for 29% of the total deaths from all causes.[8]
  • In the year 2000, it was estimated that 9.2 million potentially productive years of life were lost due to deaths secondary to CAD in the age group of 35 to 64 years and that number is expected to rise to a loss of 17.9 million years by the year 2030 which is 940% more than the projected figure for the U.S.[9]
  • The prevalence of CAD has been increasing in China with increase in risk factors such as smoking and mean cholesterol levels which have increased from 166 mg/dL to 206 mg/dL over the past 15 years.[10]

References

  1. ↑ 1.0 1.1 Gordon T, Kannel WB, Hjortland MC, McNamara PM (1978). "Menopause and coronary heart disease. The Framingham Study". Ann Intern Med. 89 (2): 157–61. PMID 677576.
  2. ↑ Lerner DJ, Kannel WB (1986). "Patterns of coronary heart disease morbidity and mortality in the sexes: a 26-year follow-up of the Framingham population". Am Heart J. 111 (2): 383–90. PMID 3946178.
  3. ↑ Kannel WB (1987). "Prevalence and clinical aspects of unrecognized myocardial infarction and sudden unexpected death". Circulation. 75 (3 Pt 2): II4–5. PMID 3493089.
  4. ↑ Lloyd-Jones D, Adams RJ, Brown TM, Carnethon M, Dai S, De Simone G; et al. (2010). "Executive summary: heart disease and stroke statistics--2010 update: a report from the American Heart Association". Circulation. 121 (7): 948–54. doi:10.1161/CIRCULATIONAHA.109.192666. PMID 20177011.
  5. ↑ Castelli WP (1984). "Epidemiology of coronary heart disease: the Framingham study". Am J Med. 76 (2A): 4–12. PMID 6702862.
  6. ↑ Roger VL, Go AS, Lloyd-Jones DM, Adams RJ, Berry JD, Brown TM; et al. (2011). "Heart disease and stroke statistics--2011 update: a report from the American Heart Association". Circulation. 123 (4): e18–e209. doi:10.1161/CIR.0b013e3182009701. PMID 21160056.
  7. ↑ Constant J (1997). "Alcohol, ischemic heart disease, and the French paradox". Coron Artery Dis. 8 (10): 645–9. PMID 9457446.
  8. ↑ 8.0 8.1 Srinath Reddy K, Shah B, Varghese C, Ramadoss A (2005) Responding to the threat of chronic diseases in India. Lancet 366 (9498):1744-9. DOI:10.1016/S0140-6736(05)67343-6 PMID: 16291069
  9. ↑ Leeder S, Raymond S, Greenberg H, Liu H, Esson K. A Race Against TimeThe Challenge of Cardiovascular Disease in Developing Countries. New York, NY: Columbia University; 2005.
  10. ↑ Critchley J, Liu J, Zhao D, Wei W, Capewell S (2004). "Explaining the increase in coronary heart disease mortality in Beijing between 1984 and 1999". Circulation. 110 (10): 1236–44. doi:10.1161/01.CIR.0000140668.91896.AE. PMID 15337690.


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