Chronic stable angina epidemiology and demographics
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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, and stable angina is the initial manifestation of ischemic heart disease in approximately 50% of these patients.
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[1]. 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[2]. 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[3].
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[4].
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.
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[5].
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[5]. 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 are 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.[6].
The prevalence of CAD has been increasing in China with increase in risk factors such as smoking and mean cholesterol levels which has increased from 166 mg/dL to 206 mg/dL over 15years[7].
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[8][9].
Sex
Incidence of CHD is greater in males when compared to premenopausal women. However, the incidence increases in postmenopausal women[8]. 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[10].
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[11].
References
- ↑ 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.
- ↑ Castelli WP (1984). "Epidemiology of coronary heart disease: the Framingham study". Am J Med. 76 (2A): 4–12. PMID 6702862.
- ↑ 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.
- ↑ Constant J (1997). "Alcohol, ischemic heart disease, and the French paradox". Coron Artery Dis. 8 (10): 645–9. PMID 9457446.
- ↑ 5.0 5.1 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
- ↑ 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.
- ↑ 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.
- ↑ 8.0 8.1 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.
- ↑ 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.
- ↑ Hemingway H, McCallum A, Shipley M, Manderbacka K, Martikainen P, Keskimäki I (2006). "Incidence and prognostic implications of stable angina pectoris among women and men". JAMA. 295 (12): 1404–11. doi:10.1001/jama.295.12.1404. PMID 16551712.
- ↑ Kannel WB (1987). "Prevalence and clinical aspects of unrecognized myocardial infarction and sudden unexpected death". Circulation. 75 (3 Pt 2): II4–5. PMID 3493089.