The National Cardiovascular Intelligence Network Cardiovascular disease key facts. Coronary heart disease (CHD) and heart failure

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1 Fact sheet number 12 The National Cardiovascular Intelligence Network Cardiovascular disease key facts Coronary heart disease (CHD) and heart failure This fact sheet is one in a series which outlines some key facts about the epidemiology of cardiovascular disease (CVD) and its risk factors. The Cardiovascular Disease Outcomes Strategy stresses the need to consider CVD as a single family of diseases and conditions linked by common risk factors, and with a common and consistent approach to management. These fact sheets are aimed at commissioners of CVD services and health and social care professionals with an interest in CVD. They provide estimates of the scale of CVD in England to aid the planning and delivery of services. They have been developed by the National Cardiovascular Intelligence Network in conjunction with experts from the CVD field. Each fact sheet uses quotes or paraphrases from published sources, followed by the full reference. We have used sources which have been appraised or quality checked although when these were not available we have used other sources which have been recommended by experts within the CVD field. For details of the development of the fact sheets please see the methods and glossary document available at Key facts about Coronary Heart Disease (CHD) Deaths from CHD have been falling since the early 1970s, and dropped by 62% for men and 64% for women between 1995 and Deaths within 30 days of emergency admission for a myocardial infarction have reduced by 37.9% from 7,899 per 100,000 in 2001/02 to 4,906 per 100,000 in 2010/11. In most areas the number of people on GP CHD registers is lower than would be expected. 1 Fact sheet number 12

2 What is CHD? CHD and ischaemic heart disease (IHD) are terms which are used interchangeably. They describe what happens when the blood supply to heart muscle is reduced or suddenly interrupted by a build up of fatty material (atheroma) and associated blood clot (thrombus) in the coronary arteries. This can cause angina, heart attack and progressive heart muscle damage. NHS Choices. Coronary heart disease, 2012 [cited 2013 Nov 1]. Available from: Conditions/Coronary-heart-disease/Pages/Introduction.aspx and Page 79 A myocardial infarction (MI) or heart attack is a serious medical emergency in which the supply of blood to an area of the heart is suddenly blocked, usually by a blood clot. Lack of blood to the heart can seriously damage the heart muscle. NHS Choices. Heart attack, 2012 [cited 2013 Nov 1]. Available from: Angina describes the symptoms of chest discomfort that occur when narrowing of the coronary arteries prevents enough oxygen-containing blood from reaching the heart muscle, especially when its demands are high, such as during exercise. Page 77 It can be either stable angina (which happens as a result of an obvious trigger, such as exercise, and improves with medication and rest) or unstable angina (where angina attacks are more unpredictable, rapidly worsening or occurring with no obvious trigger and continuing despite resting). NHS Choices. Angina, 2012 [cited 2013 Nov 1]. Available from: pages/introduction.aspx Heart failure is when the heart is less efficient at pumping blood around the body. It may result from structural heart abnormalities, longstanding high blood pressure (hypertension) or damage to the heart muscle caused by a heart attack, either at the time of the attack or many months or even years afterwards. There are typically symptoms of reduced capacity to exercise, breathlessness during exertion or lying down and, sometimes, swelling of the ankles. Page 77 What are the risk factors for CHD? A number of common risk factors are recognised as increasing the likelihood of individuals developing atherosclerosis and therefore CHD. There are three broad groups. 2 Fact sheet number 12

3 Fixed risk factors are non-modifiable, but are taken into account in advising people about their overall risk. These include age, gender, deprivation and family history/genetic factors. Variation in CHD levels by fixed risk factors is described below. Lifestyle/behavioural risk factors (such as smoking, physical inactivity, poor diet and obesity) reflect an individual s circumstances and choices, and can be changed for the better to reduce personal risk of developing health problems. Bodily risk factors reflect changes to body systems that are also reversible or preventable in their early stages, but may require more medical treatment. These include hypertension, raised cholesterol, diabetes and chronic kidney disease. The epidemiology of these risk factors is described in other documents within this CVD fact sheet series, available at ly/cvdkeyfacts. Page 11 Who is at risk of CHD? The prevalence of CHD increases with age for both men and women. In 2011 in the 25 to 34 age group 0.2% of men and 0.4% of women had CHD, rising to 26.7% (men) and 16.5% (women) in the 75 and over age group. Overall significantly more men than women had CHD (5.7% and 3.5% respectively). Oyebode O. Cardiovascular disease. In: Craig R, Mindell, J, editors. Health survey for England 2011: volume 1: health, social care and lifestyles. Leeds: Health and Social Care Information Centre; p [cited 2013 Nov 1]. Available from: Pages 21 and 45 CHD generally affects more men than women, but from the age of 50 the chances of developing CHD are similar for men and women. NHS Choices. Coronary Heart Disease, 2013 [cited 2013 Nov 1]. Available from: Conditions/Coronary-heart-disease/Pages/Introduction.aspx There is a social gradient in the prevalence of CHD, with more deprived areas experiencing higher levels than less deprived areas. In 2011 in the most deprived areas 11% of men and 5% of women were diagnosed with CHD compared to 5% of men and 2% of women in the least deprived areas. Oyebode O. Cardiovascular disease. In: Craig R, Mindell, J, editors. Health survey for England 2011: volume 1: health, social care and lifestyles. Leeds: Health and Social Care Information Centre; p [cited 2013 Nov 1]. Available from: Page 27 The risk of having angina recorded by general practice was higher in men than women in England in In 2010 in women the rate of MI was under half the rate compared to men.59% (from 136 to 56 per 100,000). British Heart Foundation. Coronary heart disease statistics, 2012 [cited 2013 Nov 1]. Available from: Pages 64 and 66 Some ethnic minority groups have a higher risk of getting CHD compared to white British groups. In England, the HSE (2004) found that the prevalence of CHD is highest 3 Fact sheet number 12

4 in Pakistani (8%), Indian (6%) and Irish (6%) men. Mindell J, Zaninotto P. Cardiovascular disease and diabetes. In: Sproston K, Mindell J, editors. Health survey for England 2004: volume 1: the health of ethnic minority groups. Leeds: The Information Centre; p [cited 2013 Nov 1]. Available from: Page 81 First-degree relatives (including parents, full brothers and sisters, or children) of patients with premature myocardial infarction (before the age of 55 years in men and 60 years in women) have double the risk of developing CHD compared to the general population. Chow CK, Pell AC, Walker A et al. Families of patients with premature coronary heart disease: an obvious but neglected target for primary prevention. BMJ. 2007;335:481-5 How common is CHD in England? In 2011 it was estimated that 4.6% of people aged 16 and over had CHD. Health and Social Care Information Centre. Health Survey for England 2011: trend tables, 2012 [cited 2013 Nov 1]. Available from: In 2013 there are 1,870,395 people on GP lists in England with diagnosed and recorded CHD. This equates to 3.3% of the population registered with a GP and highlights that not all people with CHD are included on GP CHD registers. The Health and Social Care Information Centre. Quality and Outcomes Framework , 2013 [cited 2013 Nov 1]. Available from: In % of men and 3.3% of women aged 16 years and above reported that they had ever been diagnosed with angina by a doctor. NHS Information Centre. Health survey for England 2006: CVD and risk factors for adults obesity and risk factors for children, Available from: Page 32 It was estimated that in 2011 almost two million people in England currently have or have had angina. NICE. Clinical Guideline 126: management of stable angina, 2011 [cited 2013 Nov 1]. Available from: Page 4 The incidence of heart attacks in 2010 in England in the 85 and over age group was 199 per 100,000 (men) and 139 per 100,000 (women) compared with 53 per 100,000 (men) and 24 per 100,000 (women) in people aged 65 to 74 years. British Heart Foundation. Coronary heart disease statistics, 2012 [cited 2013 Nov 1]. Available from: Page 64 In 2013 there are 397,548 people on GP lists in England with diagnosed and recorded heart failure (0.7% of the population). Of these, 213,828 (0.4% of the total population) are recorded with heart failure because of problems with the left side of their heart (left ventricular dysfunction). The Health and Social Care Information Centre. Quality and Outcomes Framework , 2013 [cited 2013 Nov 1]. Available from: 4 Fact sheet number 12

5 Is the prevalence of CHD changing over time? In 1994 the prevalence of CHD was recorded as 6.0% in men and 4.1% in women. From 1994 there was a slight increase in prevalence, but it is now decreasing and in 2011 was, 5.7% in men and 3.5% in women. Health and Social Care Information Centre. Health Survey for England 2011: trend tables, 2012 [cited 2013 Nov 1]. Available from: Does the prevalence of CHD vary across England? In most areas the number of people on GP CHD registers is lower than would be expected. In one Primary Care Trust in England in 2011 as few as 38.8% of the expected number of people with CHD were included on the GP register. NHS Right Care. Atlas of Variation 2011, 2011 [cited 2013 Nov 1]. Available from: nhs.uk/index.php/atlas/atlas-of-variation-2011/ Page 121 How is the number of deaths related to CHD changing over time? Death from CHD has been reducing over time. Between 1995 and 2012 there was a 62% reduction for men from 249 per 100,000 in 1995 to 94 per 100,000 in It is predicted that by 2020 it will have dropped by 76% to 59 per 100,000. The death rate for women in the same period dropped 64% from 117 per 100,000 to 42 per 100,000 and it is predicted that by 2020 it will have dropped by 78.1% to 25 per 100,000. National Cardiovascular Intelligence Network. Figures calculated using ONS Mortality data ICD-10 v2010 bridge coding [unpublished] CHD deaths, all ages, England 1995 to 2012 (predicted to 2020) Source: National Cardiovascular Intelligence Network. Figures calculated using ONS Mortality data ICD- 10 v2010 bridge coding [unpublished] trend calculated using a log linear trend Deaths within 30 days of a coronary artery bypass graft have dropped by a third from 2,451 per 100,000 in 2001/02 to 1,636 per 100,000 in 2010/11. Deaths within 30 days of hospital procedure: coronary artery bypass graft, all ages, annual trend, P cited in Health and Social Care Information Centre. Indicator portal [cited 2013 Nov 1]. Available from: 5 Fact sheet number 12

6 In people aged 35 to 74 years old, deaths within 30 days of emergency admission for a heart attack have dropped 42% from 8,594 per 100,000 in 2001/02 to 4,989 in 2010/11. Deaths within 30 days of emergency admission to hospital: myocardial infarction: indirectly standardised rate, years, annual trend, P cited in Health and Social Care Information Centre. Indicator portal [cited 2013 Nov 1]. Available from: How does the number of deaths from CHD in England compare with other countries? Despite substantial reductions, the UK still has mortality rates from CHD that are significantly above the average of selected other European countries (the EU15+ group of countries). Murray C et al. UK health performance: findings of the Global Burden of Disease Study Lancet : In a typical population of half a million you would expect: 16,700 people with a diagnosis of CHD 2,100 people with a diagnosis of heart failure due to left ventricular dysfunction 600 admissions with a primary diagnosis of MI per year 560 deaths each year from CHD, 180 of which are in those aged under 75 National Cardiovascular Intelligence Network. Unpublished figures calculated using fact sheet sources. This fact sheet uses information from the Health and Social Care Information Centre. Copyright 2013, Re-used with the permission of the Health and Social Care Information Centre. All rights reserved. Crown copyright 2013 You may re-use this information (excluding logos) free of charge in any format or medium, under the terms of the Open Government Licence v2.0. To view this licence, visit OGL or Where we have identified any third party copyright information you will need to obtain permission from the copyright holders concerned. Any enquiries regarding this publication should be sent to Published December Fact sheet number 12 PHE publications gateway number: 2013_237

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