Choroba wieńcowa
Epidemiologia
Choroba wieńcowa (CHD) pozostaje jedną z głównych przyczyn zgonów globalnie, odpowiadając za 13% wszystkich zgonów na świecie, z 9,1 milionami zgonów w 2021 roku. W USA chorobą wieńcową dotkniętych jest około 15,5 miliona osób powyżej 20. roku życia (6,4% populacji), z wyższą częstością u mężczyzn (7,9%) niż u kobiet (5,1%). W Europie CHD stanowi około 40-47% wszystkich zgonów sercowo-naczyniowych, a w Wielkiej Brytanii powoduje 13% zgonów mężczyzn i 8% kobiet. Czynniki ryzyka choroby wieńcowej obejmują nadciśnienie tętnicze, hipercholesterolemię, palenie tytoniu, cukrzycę (z 2-5-krotnie zwiększonym ryzykiem u chorych), otyłość, brak aktywności fizycznej, niezdrową dietę, nadmierne spożycie alkoholu oraz stres psychospołeczny. Badanie INTERHEART wskazuje, że nieprawidłowe profile lipidowe odpowiadają za 45% zawałów serca w Europie Zachodniej, a bierne palenie zwiększa ryzyko CHD o 25-30%, z 60% wyższą śmiertelnością u palaczy.
- Epidemiologia choroby wieńcowej
- Globalne rozpowszechnienie choroby wieńcowej
- Różnice regionalne w zapadalności na chorobę wieńcową
- Czynniki ryzyka choroby wieńcowej
- Różnice płciowe w chorobie wieńcowej
- Nadzór nad chorobą wieńcową
- Systemy nadzoru nad chorobą sercowo-naczyniową
- Zalety i ograniczenia systemów nadzoru opartych na EHR
- Trendy i wzorce w nadzorze nad chorobą wieńcową
- Znaczenie ekonomiczne i obciążenie systemów opieki zdrowotnej
- Programy i strategie zapobiegania chorobie wieńcowej
- Wnioski i perspektywy
Epidemiologia choroby wieńcowej
Choroba wieńcowa (ang. Coronary Heart Disease, CHD) stanowi jedną z głównych przyczyn zgonów na świecie. Pomimo stopniowego spadku śmiertelności z powodu choroby wieńcowej w krajach rozwiniętych w ostatnich dziesięcioleciach, schorzenie to nadal jest przyczyną około jednej trzeciej wszystkich zgonów u osób powyżej 35. roku życia.12 Według danych Światowej Organizacji Zdrowia (WHO), choroba niedokrwienna serca odpowiada za 13% wszystkich zgonów na świecie, ze wzrostem liczby zgonów o 2,7 miliona do 9,1 miliona w 2021 roku.3
Globalne rozpowszechnienie choroby wieńcowej
Choroba wieńcowa dotyka miliony ludzi na całym świecie, przy czym jej rozpowszechnienie różni się w zależności od regionu geograficznego. Według danych z 2010 roku, choroba wieńcowa była wiodącą przyczyną zgonów na świecie, powodując ponad 7 milionów zgonów rocznie.4 W Stanach Zjednoczonych około 15,5 miliona osób powyżej 20. roku życia cierpi na chorobę wieńcową, co odpowiada ogólnemu rozpowszechnieniu na poziomie 6,4% (7,9% u mężczyzn i 5,1% u kobiet).56
W Europie, choroba sercowo-naczyniowa powoduje szacunkowo 4 miliony zgonów rocznie, z czego 1,9 miliona w Unii Europejskiej, w dużej mierze z powodu choroby wieńcowej, stanowiąc odpowiednio 47% i 40% wszystkich zgonów w Europie i Unii Europejskiej.7 W Wielkiej Brytanii choroba wieńcowa jest odpowiedzialna za około 66 000 zgonów rocznie, powodując 13% zgonów mężczyzn i 8% zgonów kobiet.8
Różnice regionalne w zapadalności na chorobę wieńcową
Istnieją znaczące różnice regionalne w występowaniu choroby wieńcowej. Kraje rozwinięte wykazują tendencję spadkową w zapadalności na CHD w ostatnich dekadach, co może być wynikiem zarówno skutecznego leczenia ostrej fazy, jak i ulepszonych środków profilaktyki pierwotnej i wtórnej. Natomiast kraje rozwijające się wykazują znaczną zmienność w zapadalności na CHD.910
W Stanach Zjednoczonych zapadalność na CHD spadła w ostatnich dziesięcioleciach o 114-133 przypadki na 100 000 osobolat obserwacji.11 Z kolei najbardziej wyraźny wzrost zapadalności na incydenty wieńcowe na świecie odnotowano na Bliskim Wschodzie, w Ameryce Łacińskiej i, w mniejszym stopniu, na Dalekim Wschodzie.12
W Indiach badania wykazały wzrost częstości występowania CHD w ciągu ostatnich 60 lat, z 1% do 9-10% w populacjach miejskich i z 1% do 4-6% w populacjach wiejskich.13 Szacuje się, że 60% światowego obciążenia chorobami sercowo-naczyniowymi wystąpi w regionie Azji Południowej, mimo że region ten stanowi tylko 20% światowej populacji.14
Czynniki ryzyka choroby wieńcowej
Na rozwój choroby wieńcowej wpływa szereg czynników ryzyka, które można podzielić na modyfikowalne i niemodyfikowalne. Badania wykazały, że główne modyfikowalne czynniki ryzyka obejmują nadciśnienie tętnicze, wysokie stężenie cholesterolu i palenie tytoniu.1516
Inne istotne czynniki ryzyka to:
- Cukrzyca – mężczyźni z cukrzycą typu 2 mają 2-4 razy większe roczne ryzyko CHD; kobiety mają 3-5 razy większe ryzyko17
- Otyłość – niezależny czynnik ryzyka CHD18
- Brak aktywności fizycznej19
- Niezdrowa dieta bogata w tłuszcze nasycone i sód20
- Nadmierne spożycie alkoholu21
- Stres psychospołeczny22
Wyniki badania INTERHEART wykazały, że 45% zawałów serca w Europie Zachodniej jest spowodowanych nieprawidłowymi lipidami krwi.23 Ponadto, regularny kontakt z biernym paleniem zwiększa ryzyko CHD o 25-30%, a śmiertelność z powodu CHD jest o 60% wyższa u palaczy.24
Różnice płciowe w chorobie wieńcowej
Istnieją znaczące różnice w występowaniu i manifestacji choroby wieńcowej między płciami. Mężczyźni mają wyższą częstość występowania CHD niż kobiety, przy czym mężczyźni wykazują wskaźnik śmiertelności 2-4 razy wyższy niż kobiety w większości krajów uprzemysłowionych.25
Według danych z badania Framingham, częstość występowania incydentów wieńcowych gwałtownie wzrasta wraz z wiekiem, a kobiety mają wskaźniki podobne do tych u mężczyzn 10 lat młodszych (średnie opóźnienie o 10 lat we wskaźnikach zapadalności).26 Ogólna zapadalność na CHD w wieku 65-95 lat jest dwukrotnie wyższa u mężczyzn i trzykrotnie wyższa u kobiet w porównaniu do wskaźników osób w wieku 35-64 lat.27
W Stanach Zjednoczonych, standaryzowany według wieku wskaźnik rozpowszechnienia choroby serca u mężczyzn spadł z 8,3% w 2009 roku do 7,2% w 2018 roku, natomiast u kobiet spadł z 4,6% w 2009 roku do 4,1% w 2018 roku.2829
Nadzór nad chorobą wieńcową
Nadzór nad chorobą wieńcową obejmuje ilościowe określenie ewoluującego obciążenia populacji wynikami choroby sercowo-naczyniowej i czynnikami ryzyka jako pierwszy krok oparty na danych, po którym następuje wdrożenie strategii interwencyjnych mających na celu złagodzenie tego obciążenia w populacji docelowej.30
Systemy nadzoru nad chorobą sercowo-naczyniową
Pomimo powszechnego uznania jego potencjalnej wartości, krajowy system nadzoru dedykowany specjalnie chorobom sercowo-naczyniowym nie istnieje obecnie w Stanach Zjednoczonych.31 Idealny krajowy system nadzoru nad CVD śledziłby w sposób efektywny kosztowo duży, reprezentatywny zestaw mieszkańców USA przez dłuższy czas, śledząc szeroki zakres wskaźników, tak aby powstał kompleksowy obraz stanu zdrowia sercowo-naczyniowego narodu.32
W ostatnich latach wzrosło zainteresowanie wykorzystaniem danych z elektronicznej dokumentacji medycznej (EHR) do badań, oceny inicjatyw poprawy jakości i monitorowania zdrowia publicznego, w tym ustanowienia krajowego systemu nadzoru nad CVD.33 Dane EHR mają tendencję do reprezentowania szerszej populacji pacjentów niż izolowane źródła danych roszczeń i są bardziej dostępne w czasie rzeczywistym.34
Zalety i ograniczenia systemów nadzoru opartych na EHR
Kluczowe zalety wykorzystania danych EHR do ustanowienia krajowego systemu nadzoru nad CVD obejmują:
- Wszechobecność EHR i wynikającą z tego zdolność do stworzenia bardziej krajowego systemu nadzoru35
- Istnienie wspólnej infrastruktury danych stanowiącej podstawę przedsiębiorstwa opieki zdrowotnej w odniesieniu do domen danych i nazewnictwa, za pomocą którego dane te są wyrażane36
- Długość i szczegółowość podłużną, które definiują dane EHR, gdy osoby wielokrotnie korzystają z organizacji opieki zdrowotnej37
- Szeroki zakres wyników, które można nadzorować za pomocą EHR38
Kluczowe ograniczenia obejmują:
- Niepełne rozpoznanie informacji zdrowotnych związanych z zachowaniami związanymi z poszukiwaniem opieki zdrowotnej i rozłączenie danych opieki zdrowotnej generowanych w oddzielnych organizacjach opieki zdrowotnej39
- Podejrzana jakość danych wynikająca z domyślnych procesów gromadzenia informacji w przedsiębiorstwie klinicznym40
- Wątpliwa zdolność do nadzorowania pacjentów poprzez EHR w przypadku braku udokumentowanych interakcji41
- Wyzwanie w interpretacji trendów czasowych w metrykach zdrowotnych, które mogą być zaciemnione przez zmieniające się procesy kliniczne i administracyjne42
Trendy i wzorce w nadzorze nad chorobą wieńcową
Dane epidemiologiczne dotyczące chorób serca, udaru i powiązanych czynników ryzyka są kompilowane i publikowane corocznie w Heart Disease and Stroke Statistical Update. Ta publikacja jest wynikiem współpracy American Heart Association (AHA), Centers for Disease Control and Prevention, National Institutes of Health i innych agencji rządowych.43
Według danych z raportu Heart Disease and Stroke Statistics 2011 Update, około 82,6 miliona osób w Stanach Zjednoczonych ma obecnie jedną lub więcej form choroby sercowo-naczyniowej (CVD), co czyni ją główną przyczyną śmierci zarówno mężczyzn, jak i kobiet.44
| Grupa demograficzna | Rozpowszechnienie CHD |
|---|---|
| Ogólnie (USA) | 7% |
| Mężczyźni (USA) | 8,3% |
| Kobiety (USA) | 6,1% |
| Nie-hiszpańscy biali mężczyźni | 8,5% |
| Nie-hiszpańscy czarni mężczyźni | 7,9% |
| Mężczyźni pochodzenia meksykańskiego | 6,3% |
| Nie-hiszpańskie czarne kobiety | 7,6% |
| Nie-hiszpańskie białe kobiety | 5,8% |
| Kobiety pochodzenia meksykańskiego | 5,6% |
Dane z badania Strong Heart Study, finansowanego przez National Heart, Lung, and Blood Institute (NHLBI), wykazały, że częstość występowania CHD u Indian amerykańskich w wieku od 45 do 74 lat wynosiła 17,9 na 1000 osobolat: 23,2 na 1000 osobolat u mężczyzn i 14,8 u kobiet.45
Znaczenie ekonomiczne i obciążenie systemów opieki zdrowotnej
Choroba wieńcowa stanowi ogromne obciążenie ekonomiczne dla systemów opieki zdrowotnej na całym świecie. Bezpośrednie i pośrednie koszty chorób sercowo-naczyniowych i udaru w Stanach Zjednoczonych szacuje się na ponad 286 miliardów dolarów.46
W Indonezji oszacowano, że wśród osób w wieku produkcyjnym, które obecnie mają CHD, 33,3 miliarda dolarów zostałoby utraconych w PKB do czasu, gdy wszyscy członkowie kohorty osiągną wiek 55 lat. Założono, że każdy Indonezyjczyk w wieku produkcyjnym z CHD poniesie 5720 dolarów kosztów opieki zdrowotnej rocznie.47
Koszty ekonomiczne związane z diagnozą i leczeniem chorób sercowo-naczyniowych (w tym udaru) są szacowane na 315 miliardów dolarów w 2014 roku.48 W Stanach Zjednoczonych, około 14 milionów osób doświadcza choroby wieńcowej (CAD) i jej różnych powikłań. Niewydolność serca zastoinowa (CHF), która rozwija się z powodu kardiomiopatii niedokrwiennej u osób z nadciśnieniem, które przeżyły zawał serca, stała się najczęstszą diagnozą wypisową dla pacjentów w amerykańskich szpitalach.49
Programy i strategie zapobiegania chorobie wieńcowej
Biorąc pod uwagę ogromne obciążenie zdrowotne i ekonomiczne związane z chorobą wieńcową, implementacja skutecznych strategii profilaktycznych jest kluczowa. Kilka krajowych programów i inicjatyw zostało ustanowionych w celu zwalczania czynników ryzyka chorób sercowo-naczyniowych:
Krajowe programy edukacyjne
W Stanach Zjednoczonych ustanowiono kilka krajowych programów edukacyjnych mających na celu zmniejszenie czynników ryzyka chorób sercowo-naczyniowych:
- Narodowy Program Edukacji o Nadciśnieniu Tętniczym (NHBPEP) został ustanowiony w 1972 roku i jest koordynowany przez NHLBI. Program działa na rzecz osiągnięcia celów Healthy People 2010 w zakresie zapobiegania chorobom serca i udarom.50
- Narodowy Program Edukacji o Cholesterolu (NCEP) został ustanowiony przez NHLBI w 1985 roku w celu zmniejszenia odsetka Amerykanów z wysokim poziomem cholesterolu i wynikającej z tego choroby wieńcowej.51
- Inicjatywa Edukacyjna Otyłości (OEI) została uruchomiona przez NHLBI w 1991 roku w celu zmniejszenia częstości występowania nadwagi, otyłości i braku aktywności fizycznej.52
- Narodowy Program Edukacji o Cukrzycy (NDEP) został ustanowiony w 1997 roku i jest finansowany przez National Institutes of Health i CDC.53
Inicjatywy zapobiegania chorobie sercowo-naczyniowej
Inicjatywa Million Hearts 2027 to krajowy wysiłek mający na celu zapobieganie 1 milionowi zawałów serca i udarów w ciągu pięciu lat poprzez promowanie programów profilaktyki społecznej i klinicznej.54 Healthy People 2030 zapewnia kilka celów związanych z poprawą zdrowia serca, w tym:
- Poprawę zdrowia sercowo-naczyniowego wśród dorosłych
- Zmniejszenie liczby zgonów z powodu choroby wieńcowej
- Zmniejszenie liczby zgonów z powodu udaru mózgu
- Zwiększenie kontroli ciśnienia krwi u dorosłych
- Zwiększenie leczenia cholesterolu u dorosłych55
WHO pracuje obecnie nad zwiększeniem dostępnych wytycznych normatywnych dotyczących zarządzania ostrym zespołem wieńcowym i udarem, które zapewnią wskazówki w tych ważnych obszarach.56 Dowody z 18 krajów wykazały, że programy przeciw nadciśnieniu mogą być skutecznie i efektywnie kosztowo wdrażane na poziomie podstawowej opieki zdrowotnej, co ostatecznie doprowadzi do zmniejszenia liczby przypadków choroby wieńcowej i udaru.57
Wnioski i perspektywy
Choroba wieńcowa pozostaje główną przyczyną śmierci na całym świecie, z istotnymi różnicami regionalnymi w jej występowaniu i trendach. Podczas gdy kraje rozwinięte odnotowały spadek śmiertelności z powodu CHD w ostatnich dziesięcioleciach, obciążenie chorobą pozostaje znaczne, a w krajach rozwijających się oczekuje się wzrostu częstości występowania CHD.58
Chociaż częstość występowania CHD spada w krajach rozwiniętych, imigracja i postępujące starzenie się populacji sugerują, że bezwzględna liczba incydentów wieńcowych, a w konsekwencji częstość występowania CHD, nie zmniejszy się, a nawet może wzrosnąć w najbliższej przyszłości.59
Globalizacja zachodniej diety i zwiększony siedzący tryb życia będą miały dramatyczny wpływ na postępujący wzrost zapadalności na CHD w krajach rozwijających się.6061 Oczekuje się, że umieralność z powodu chorób niezakaźnych, w tym CHD, wzrośnie w nadchodzących dziesięcioleciach z powodu pogorszenia metabolicznych czynników ryzyka.62
Efektywne strategie w zarządzaniu, edukacji i ośrodkach opieki zdrowotnej są wymagane dla dokładnego zarządzania i wdrażania środków zapobiegawczych.63 Zmniejszenie obciążenia CHD będzie wymagało zmian zarówno na poziomie polityki, jak i na poziomie indywidualnym. Interesariusze powinni celować w te czynniki ryzyka poprzez polityki zdrowia publicznego, co może być najlepszym sposobem przerwania tego trendu.64
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Materiały źródłowe
- #1 Epidemiology of coronary heart disease and acute coronary syndromehttps://pmc.ncbi.nlm.nih.gov/articles/PMC4958723/
The aim of this review is to summarize the incidence, prevalence, trend in mortality, and general prognosis of coronary heart disease (CHD) and a related condition, acute coronary syndrome (ACS). Although CHD mortality has gradually declined over the last decades in western countries, this condition still causes about one-third of all deaths in people older than 35 years. […] CHD is a major cause of death and disability in developed countries. […] The Framingham Heart Study perfectly summarizes the risk factors that contribute to the development of CHD, providing critical information regarding objectives for the primary and secondary prevention of CHD. […] The 2016 Heart Disease and Stroke Statistics update of the American Heart Association (AHA) has recently reported that 15.5 million persons 20 years of age in the USA have CHD, whilst the reported prevalence increases with age for both women and men and it has been estimated that approximately every 42 seconds, an American will suffer for an MI.
- #2 The Epidemiology of Coronary Heart Disease – Revista Española de CardiologÃa (English Edition)https://www.revespcardiol.org/en-the-epidemiology-coronary-heart-disease-articulo-S1885585713003381
Understanding the societal impact and trends of coronary heart disease through basic epidemiological measures is essential to evaluate treatment effectiveness and organize resource distribution. In the following narrative review, data are presented on the prevalence, incidence, and prognosis of coronary heart disease in general and of acute coronary syndrome in particular. […] Although the mortality rate from ischemic heart disease has decreased in the last 4 decades in developed countries, it continues to cause approximately one third of all deaths in persons older than 35 years of age. […] It has been estimated that almost half of middle-aged men and one third of middle-aged women in the United States will have some symptoms of ischemic heart disease. […] Meanwhile, cardiovascular disease causes an estimated annual total of 4 million deaths in Europe and of 1.9 million deaths in the European Union, largely due to coronary heart disease (CHD), representing 47% and 40% of all deaths in Europe and the European Union, respectively.
- #3 Coronary artery disease – Wikipediahttps://en.wikipedia.org/wiki/Coronary_artery_disease
As of 2010, CAD was the leading cause of death globally resulting in over 7 million deaths. […] The World Health Organization reported that: „The world’s biggest killer is ischemic heart disease, responsible for 13% of the world’s total deaths. Since 2000, the largest increase in deaths has been for this disease, rising by 2.7 million to 9.1 million deaths in 2021.” […] Coronary artery disease is the leading cause of death for both males and females and accounts for approximately 600,000 deaths in the United States every year. […] According to present trends in the United States, half of healthy 40-year-old males will develop CAD in the future, and one in three healthy 40-year-old females. […] It is the most common reason for death of males and females over 20 years of age in the United States. […] After analysing data from 2 111 882 patients, the recent meta-analysis revealed that the incidence of coronary artery diseases in breast cancer survivors was 4.29 (95% CI 3.095.94) per 1000 person-years.
- #4 Coronary artery disease – Wikipediahttps://en.wikipedia.org/wiki/Coronary_artery_disease
As of 2010, CAD was the leading cause of death globally resulting in over 7 million deaths. […] The World Health Organization reported that: „The world’s biggest killer is ischemic heart disease, responsible for 13% of the world’s total deaths. Since 2000, the largest increase in deaths has been for this disease, rising by 2.7 million to 9.1 million deaths in 2021.” […] Coronary artery disease is the leading cause of death for both males and females and accounts for approximately 600,000 deaths in the United States every year. […] According to present trends in the United States, half of healthy 40-year-old males will develop CAD in the future, and one in three healthy 40-year-old females. […] It is the most common reason for death of males and females over 20 years of age in the United States. […] After analysing data from 2 111 882 patients, the recent meta-analysis revealed that the incidence of coronary artery diseases in breast cancer survivors was 4.29 (95% CI 3.095.94) per 1000 person-years.
- #5 Epidemiology of coronary heart disease and acute coronary syndromehttps://pmc.ncbi.nlm.nih.gov/articles/PMC4958723/
The aim of this review is to summarize the incidence, prevalence, trend in mortality, and general prognosis of coronary heart disease (CHD) and a related condition, acute coronary syndrome (ACS). Although CHD mortality has gradually declined over the last decades in western countries, this condition still causes about one-third of all deaths in people older than 35 years. […] CHD is a major cause of death and disability in developed countries. […] The Framingham Heart Study perfectly summarizes the risk factors that contribute to the development of CHD, providing critical information regarding objectives for the primary and secondary prevention of CHD. […] The 2016 Heart Disease and Stroke Statistics update of the American Heart Association (AHA) has recently reported that 15.5 million persons 20 years of age in the USA have CHD, whilst the reported prevalence increases with age for both women and men and it has been estimated that approximately every 42 seconds, an American will suffer for an MI.
- #6 The Epidemiology of Coronary Heart Disease – Revista Española de CardiologÃa (English Edition)https://www.revespcardiol.org/en-the-epidemiology-coronary-heart-disease-articulo-S1885585713003381
The present narrative review of the epidemiology of CHD discusses data on the trends in the prevalence (number of existing cases in a population) and incidence (number of new cases during a specific time) of CHD, with both values used as epidemiological measures of the impact of a disease on a population. […] Most information on coronary morbidity and mortality is drawn from data provided by national surveys and observational cohort studies. […] Estimation of the true prevalence of CHD in the population is complex. […] This estimation is often performed via population surveys. […] In particular, the survey estimated that about 15.4 million persons older than 20 years in the United States have ischemic heart disease. […] This figure corresponds to an overall prevalence of CHD among those older than 20 years of 6.4% (7.9% in men and 5.1% in women).
- #7 The Epidemiology of Coronary Heart Disease – Revista Española de CardiologÃa (English Edition)https://www.revespcardiol.org/en-the-epidemiology-coronary-heart-disease-articulo-S1885585713003381
Understanding the societal impact and trends of coronary heart disease through basic epidemiological measures is essential to evaluate treatment effectiveness and organize resource distribution. In the following narrative review, data are presented on the prevalence, incidence, and prognosis of coronary heart disease in general and of acute coronary syndrome in particular. […] Although the mortality rate from ischemic heart disease has decreased in the last 4 decades in developed countries, it continues to cause approximately one third of all deaths in persons older than 35 years of age. […] It has been estimated that almost half of middle-aged men and one third of middle-aged women in the United States will have some symptoms of ischemic heart disease. […] Meanwhile, cardiovascular disease causes an estimated annual total of 4 million deaths in Europe and of 1.9 million deaths in the European Union, largely due to coronary heart disease (CHD), representing 47% and 40% of all deaths in Europe and the European Union, respectively.
- #8 Epidemiology of Coronary Heart Disease | Doctorhttps://patient.info/doctor/epidemiology-of-coronary-heart-disease
Coronary heart disease (CHD) is the most common cause of death (and premature death) in the UK. […] Coronary heart disease (CHD) is the one of the UKs leading causes of death and the most common cause of premature death. CHD is responsible for about 66,000 deaths in the UK each year. […] In 2019, CHD caused 13% of male and 8% of female deaths. It was the leading cause of death worldwide in 2019. In the UK, one in eight men and one in 14 women die from coronary heart disease. […] About 25,000 people under the age of 75 in the UK die from CHD each year. […] CHD death rates are highest in Scotland and the north of England. […] In the UK as many as 100,000 hospital admissions each year are due to myocardial infarctions. […] Although mortality from CHD is falling, morbidity appears to be rising.
- #9https://link.springer.com/article/10.2991/jegh.k.201217.001
CAD mortality and prevalence vary among countries. Estimation of the true prevalence of CAD in the population is complex. A significant number of countries have not provided data, the estimation of the exact figures for epidemiological data is a barrier. The incidence of CAD continues to fall in developed countries over the last few decades and this may be due to both effective treatment of the acute phase and improved primary and secondary preventive measures. Developing countries show considerable variability in the incidence of CAD. The globalization of the Western diet and increased sedentary lifestyle will have a dramatic influence on the progressive increase in the incidence of CAD in these countries.
- #10 Epidemiology and the Magnitude of Coronary Artery Disease and Acute Coronary Syndrome: A Narrative Review | Atlantis Presshttps://www.atlantis-press.com/journals/jegh/125950929/view
Coronary artery disease is the foremost single cause of mortality and loss of Disability Adjusted Life Years (DALYs) globally. A large number of this burden falls on low and middle income countries accounting for nearly 7 million deaths and 129 million DALYs annually. […] The incidence of CAD continues to fall in developed countries over the last few decades and this may be due to both effective treatment of the acute phase and improved primary and secondary preventive measures. Developing countries show considerable variability in the incidence of CAD. […] The globalization of the Western diet and increased sedentary lifestyle will have a dramatic influence on the progressive increase in the incidence of CAD in these countries. […] The INTERHEART study showed that there were potentially modifiable risk factors for ACS including raised Apo B/Apo A ratio, current smoking status, psychosocial factors, diabetes, hypertension, abdominal obesity, alcohol consumption, regular physical activity and daily consumption of fruits and vegetables.
- #11 The Epidemiology of Coronary Heart Disease – Revista Española de CardiologÃa (English Edition)https://www.revespcardiol.org/en-the-epidemiology-coronary-heart-disease-articulo-S1885585713003381
The overall incidence of CHD at between 65 and 95 years of age is double for men and triple for women with respect to the rates of those between 35 and 64 years. […] In general, the incidence of CHD has decreased in recent decades in the United States by between 114 and 133 cases for every 100 000 person-years of follow-up. […] This reduction has been even higher for cardiovascular disease in general (from 294 to 225 cases for every 100 000 person-years). […] Nonetheless, it is estimated that during 2013 1 citizen of the United States will have a myocardial infarction every 44s. […] In Spain, a recent methodical analysis of previously published records and official population statistics estimated the following expected distribution of ACS in 2013: 38.2% STEACS, 55.8% NSTEACS, and 6% unclassified ACS.
- #12 The Epidemiology of Coronary Heart Disease – Revista Española de CardiologÃa (English Edition)https://www.revespcardiol.org/en-the-epidemiology-of-coronary-heart-articulo-resumen-S1885585713003381?redirect=true
This temporal trend also largely applies to other developed countries but not to developing countries. […] In Spain, a similar conclusion can be drawn from raw data of the National Institute of Statistics. […] The most marked increases in the incidence of coronary events in the world have been in the Middle East, Latin America, and, to a lesser extent, the Far East. […] Although most studies have shown a downward trend in the incidence of myocardial infarction in the United States since the 1970s, some studies have shown contradictory results, above all those that cover the period after 2000. […] In Spain, a recent methodical analysis of previously published records and official population statistics estimated the following expected distribution of ACS in 2013: 38.2% STEACS, 55.8% NSTEACS, and 6% unclassified ACS.
- #13 Trends in Coronary Heart Disease Epidemiology in India | Annals of Global Healthhttps://annalsofglobalhealth.org/articles/10.1016/j.aogh.2016.04.002
Cardiovascular diseases, especially coronary heart disease (CHD), are epidemic in India. The Registrar General of India reported that CHD led to 17% of total deaths and 26% of adult deaths in 2001-2003, which increased to 23% of total and 32% of adult deaths in 2010-2013. The World Health Organization (WHO) and Global Burden of Disease Study also have highlighted increasing trends in years of life lost (YLLs) and disability-adjusted life years (DALYs) from CHD in India. In India, studies have reported increasing CHD prevalence over the last 60 years, from 1% to 9%-10% in urban populations and 1% to 4%-6% in rural populations. […] Case-control studies have reported that important risk factors for CHD in India are dyslipidemias, smoking, diabetes, hypertension, abdominal obesity, psychosocial stress, unhealthy diet, and physical inactivity. Suitable preventive strategies are required to combat this epidemic.
- #14 Cardiovascular disease – Wikipediahttps://en.wikipedia.org/wiki/Cardiovascular_disease
Cardiovascular diseases are the leading cause of death worldwide and in all regions except Africa. In 2008, 30% of all global death was attributed to cardiovascular diseases. Death caused by cardiovascular diseases are also higher in low- and middle-income countries as over 80% of all global deaths caused by cardiovascular diseases occurred in those countries. It is also estimated that by 2030, over 23 million people will die from cardiovascular diseases each year. […] It is estimated that 60% of the world’s cardiovascular disease burden will occur in the South Asian subcontinent despite only accounting for 20% of the world’s population. This may be secondary to a combination of genetic predisposition and environmental factors. Organizations such as the Indian Heart Association are working with the World Heart Federation to raise awareness about this issue.
- #15 Heart Disease Facts | Heart Disease | CDChttps://www.cdc.gov/heart-disease/data-research/facts-stats/index.html
Coronary heart disease is the most common type of heart disease. It killed 371,506 people in 2022. […] About 1 in 20 adults age 20 and older have CAD (about 5%). […] In 2022, about 1 out of every 5 deaths from cardiovascular diseases (CVDs) was among adults younger than 65 years old. […] Heart disease is the leading cause of death for people of most racial and ethnic groups in the United States. […] High blood pressure, high blood cholesterol, and smoking are key risk factors for heart disease. […] Several other medical conditions and lifestyle choices can also put people at a higher risk for heart disease, including diabetes, overweight and obesity, unhealthy diet, physical inactivity, and excessive alcohol use.
- #16 2 Cardiovascular Disease | A Nationwide Framework for Surveillance of Cardiovascular and Chronic Lung Diseases | The National Academies Presshttps://nap.nationalacademies.org/read/13145/chapter/4
Among the modifiable risk factors for cardiovascular disease is a diet that is high in saturated fat and sodium. […] Other risk factors are tobacco smoke, high blood cholesterol, high blood pressure, physical inactivity, obesity and overweight, and diabetes mellitus. […] Stress and excessive alcohol consumption may also contribute to cardiovascular disease risk. […] The prevalence of hypertension increases with age. […] U.S. blacks have the highest prevalence of hypertension in the world. […] Hypertension also increases mortality from heart disease and stroke; for every increase of 20 mmHg systolic and 10 mmHg diastolic, there is a doubling of mortality from these conditions. […] The National High Blood Pressure Education Program (NHBPEP) was established in 1972 and is coordinated by NHLBI.
- #17 Epidemiology of Coronary Heart Disease | Doctorhttps://patient.info/doctor/epidemiology-of-coronary-heart-disease
Mortality from CHD is 60% higher in smokers. […] Regular exposure to passive smoking increases CHD risk by up to 25-30%. […] World Health Organization (WHO) research estimates that over 20% of CVD is due to smoking. […] CHD risk is related to cholesterol levels. […] The INTERHEART study suggested that 45% of myocardial infarctions in Western Europe are due to abnormal blood lipids. […] Obesity is an independent risk factor for CHD. […] Men with type 2 diabetes have a 2 to 4 times greater annual risk of CHD; women have a 3 to 5 times greater risk. […] South Asian people living in the UK (people from India, Pakistan, Bangladesh and Sri Lanka) have a higher premature death rate from CHD (46% higher for men; 51% higher for women). […] First-degree relatives of patients with premature myocardial infarction have double the risk themselves.
- #18 Epidemiology of Coronary Heart Disease | Doctorhttps://patient.info/doctor/epidemiology-of-coronary-heart-disease
Mortality from CHD is 60% higher in smokers. […] Regular exposure to passive smoking increases CHD risk by up to 25-30%. […] World Health Organization (WHO) research estimates that over 20% of CVD is due to smoking. […] CHD risk is related to cholesterol levels. […] The INTERHEART study suggested that 45% of myocardial infarctions in Western Europe are due to abnormal blood lipids. […] Obesity is an independent risk factor for CHD. […] Men with type 2 diabetes have a 2 to 4 times greater annual risk of CHD; women have a 3 to 5 times greater risk. […] South Asian people living in the UK (people from India, Pakistan, Bangladesh and Sri Lanka) have a higher premature death rate from CHD (46% higher for men; 51% higher for women). […] First-degree relatives of patients with premature myocardial infarction have double the risk themselves.
- #19 2 Cardiovascular Disease | A Nationwide Framework for Surveillance of Cardiovascular and Chronic Lung Diseases | The National Academies Presshttps://nap.nationalacademies.org/read/13145/chapter/4
Among the modifiable risk factors for cardiovascular disease is a diet that is high in saturated fat and sodium. […] Other risk factors are tobacco smoke, high blood cholesterol, high blood pressure, physical inactivity, obesity and overweight, and diabetes mellitus. […] Stress and excessive alcohol consumption may also contribute to cardiovascular disease risk. […] The prevalence of hypertension increases with age. […] U.S. blacks have the highest prevalence of hypertension in the world. […] Hypertension also increases mortality from heart disease and stroke; for every increase of 20 mmHg systolic and 10 mmHg diastolic, there is a doubling of mortality from these conditions. […] The National High Blood Pressure Education Program (NHBPEP) was established in 1972 and is coordinated by NHLBI.
- #20 2 Cardiovascular Disease | A Nationwide Framework for Surveillance of Cardiovascular and Chronic Lung Diseases | The National Academies Presshttps://nap.nationalacademies.org/read/13145/chapter/4
Among the modifiable risk factors for cardiovascular disease is a diet that is high in saturated fat and sodium. […] Other risk factors are tobacco smoke, high blood cholesterol, high blood pressure, physical inactivity, obesity and overweight, and diabetes mellitus. […] Stress and excessive alcohol consumption may also contribute to cardiovascular disease risk. […] The prevalence of hypertension increases with age. […] U.S. blacks have the highest prevalence of hypertension in the world. […] Hypertension also increases mortality from heart disease and stroke; for every increase of 20 mmHg systolic and 10 mmHg diastolic, there is a doubling of mortality from these conditions. […] The National High Blood Pressure Education Program (NHBPEP) was established in 1972 and is coordinated by NHLBI.
- #21 2 Cardiovascular Disease | A Nationwide Framework for Surveillance of Cardiovascular and Chronic Lung Diseases | The National Academies Presshttps://nap.nationalacademies.org/read/13145/chapter/4
Among the modifiable risk factors for cardiovascular disease is a diet that is high in saturated fat and sodium. […] Other risk factors are tobacco smoke, high blood cholesterol, high blood pressure, physical inactivity, obesity and overweight, and diabetes mellitus. […] Stress and excessive alcohol consumption may also contribute to cardiovascular disease risk. […] The prevalence of hypertension increases with age. […] U.S. blacks have the highest prevalence of hypertension in the world. […] Hypertension also increases mortality from heart disease and stroke; for every increase of 20 mmHg systolic and 10 mmHg diastolic, there is a doubling of mortality from these conditions. […] The National High Blood Pressure Education Program (NHBPEP) was established in 1972 and is coordinated by NHLBI.
- #22 Trends in Coronary Heart Disease Epidemiology in India | Annals of Global Healthhttps://annalsofglobalhealth.org/articles/10.1016/j.aogh.2016.04.002
Cardiovascular diseases, especially coronary heart disease (CHD), are epidemic in India. The Registrar General of India reported that CHD led to 17% of total deaths and 26% of adult deaths in 2001-2003, which increased to 23% of total and 32% of adult deaths in 2010-2013. The World Health Organization (WHO) and Global Burden of Disease Study also have highlighted increasing trends in years of life lost (YLLs) and disability-adjusted life years (DALYs) from CHD in India. In India, studies have reported increasing CHD prevalence over the last 60 years, from 1% to 9%-10% in urban populations and 1% to 4%-6% in rural populations. […] Case-control studies have reported that important risk factors for CHD in India are dyslipidemias, smoking, diabetes, hypertension, abdominal obesity, psychosocial stress, unhealthy diet, and physical inactivity. Suitable preventive strategies are required to combat this epidemic.
- #23 Epidemiology of Coronary Heart Disease | Doctorhttps://patient.info/doctor/epidemiology-of-coronary-heart-disease
Mortality from CHD is 60% higher in smokers. […] Regular exposure to passive smoking increases CHD risk by up to 25-30%. […] World Health Organization (WHO) research estimates that over 20% of CVD is due to smoking. […] CHD risk is related to cholesterol levels. […] The INTERHEART study suggested that 45% of myocardial infarctions in Western Europe are due to abnormal blood lipids. […] Obesity is an independent risk factor for CHD. […] Men with type 2 diabetes have a 2 to 4 times greater annual risk of CHD; women have a 3 to 5 times greater risk. […] South Asian people living in the UK (people from India, Pakistan, Bangladesh and Sri Lanka) have a higher premature death rate from CHD (46% higher for men; 51% higher for women). […] First-degree relatives of patients with premature myocardial infarction have double the risk themselves.
- #24 Epidemiology of Coronary Heart Disease | Doctorhttps://patient.info/doctor/epidemiology-of-coronary-heart-disease
Mortality from CHD is 60% higher in smokers. […] Regular exposure to passive smoking increases CHD risk by up to 25-30%. […] World Health Organization (WHO) research estimates that over 20% of CVD is due to smoking. […] CHD risk is related to cholesterol levels. […] The INTERHEART study suggested that 45% of myocardial infarctions in Western Europe are due to abnormal blood lipids. […] Obesity is an independent risk factor for CHD. […] Men with type 2 diabetes have a 2 to 4 times greater annual risk of CHD; women have a 3 to 5 times greater risk. […] South Asian people living in the UK (people from India, Pakistan, Bangladesh and Sri Lanka) have a higher premature death rate from CHD (46% higher for men; 51% higher for women). […] First-degree relatives of patients with premature myocardial infarction have double the risk themselves.
- #25 Epidemiology and health policy | 3 | Coronary heart disease | S. Leonahttps://www.taylorfrancis.com/chapters/edit/10.4324/9781003278467-3/epidemiology-health-policy-leonard-syme-jack-guralnik
This chapter examines the degree to which epidemiologic research on coronary heart disease (CHD) has in fact had an impact on public policies regarding this disease. […] To identify links between epidemiologic research and public policy on CHD is an especially challenging task because this disease has been of great public concern. […] Three major risk factors have received most attention by medical researchers, the media, and the general public. […] CHD has its major impact in the developed countries of the world. […] Men have a greater incidence of CHD than women, with men showing a mortality rate two to four times greater than women in most industrialized countries.
- #26 The Epidemiology of Coronary Heart Disease – Revista Española de CardiologÃa (English Edition)https://www.revespcardiol.org/en-the-epidemiology-coronary-heart-disease-articulo-S1885585713003381
Although the prevalence of CHD increases with age in both men and women, another survey-based American study showed some variation in recent decades in the male:female prevalence ratio in middle-aged persons (35-54 years). […] The most recent data continue to show a strong male predominance in CHD in general and in myocardial infarction in particular in all age groups. […] The incidence rate, defined as the number of new cases of a disease in a specific population and time period, is usually estimated via cohort studies, specific registries, or official statistics, such as discharge record data. […] For example, it is known from the Framingham cohort that the incidence of coronary events rapidly increases with age and that women have rates that are similar to those of men 10 years younger (a mean delay of 10 years in the incidence rates).
- #27 The Epidemiology of Coronary Heart Disease – Revista Española de CardiologÃa (English Edition)https://www.revespcardiol.org/en-the-epidemiology-coronary-heart-disease-articulo-S1885585713003381
The overall incidence of CHD at between 65 and 95 years of age is double for men and triple for women with respect to the rates of those between 35 and 64 years. […] In general, the incidence of CHD has decreased in recent decades in the United States by between 114 and 133 cases for every 100 000 person-years of follow-up. […] This reduction has been even higher for cardiovascular disease in general (from 294 to 225 cases for every 100 000 person-years). […] Nonetheless, it is estimated that during 2013 1 citizen of the United States will have a myocardial infarction every 44s. […] In Spain, a recent methodical analysis of previously published records and official population statistics estimated the following expected distribution of ACS in 2013: 38.2% STEACS, 55.8% NSTEACS, and 6% unclassified ACS.
- #28 Heart Disease Prevalence – Health, United Stateshttps://www.cdc.gov/nchs/hus/topics/heart-disease-prevalence.htm
Heart disease is the leading cause of death for men, women, people aged 45 and over, and most race and Hispanic-origin groups. […] Improvements in medical care and reductions in risk factors associated with heart disease, such as high blood pressure, high cholesterol, smoking, and obesity, have led to declines in heart disease morbidity and mortality. […] The age-adjusted prevalence of heart disease in adults aged 18 and over decreased from 6.2% in 2009 to 5.5% in 2018. In 2019, 5.5% of adults reported that they had been diagnosed with heart disease. […] From 2009 to 2019, the respondent-reported prevalence of heart disease was higher in men than in women. […] The age-adjusted prevalence of heart disease in men decreased from 8.3% in 2009 to 7.2% in 2018. In 2019, 7.0% of men reported having heart disease.
- #29 Heart Disease Prevalence – Health, United Stateshttps://www.cdc.gov/nchs/hus/topics/heart-disease-prevalence.htm
The age-adjusted prevalence of heart disease in women decreased from 4.6% in 2009 to 4.1% in 2018. In 2019, 4.2% of women reported having heart disease. […] Adults aged 75 and over had the highest prevalence of heart disease compared with younger age groups. […] From 2009 to 2018, the respondent-reported prevalence of heart disease decreased in adults aged 55-64 and 65-74 but remained stable in adults aged 18-44, 45-54, and 75 and over. […] In 2019, the prevalence of heart disease increased with age, reported by 1.0% of adults aged 18-44, 3.6% of adults aged 45-54, 9.0% of adults aged 55-64, 14.3% of adults aged 65-74, and 24.2% of adults aged 75 and over. […] Heart disease prevalence is based on questions about whether respondents had ever been told by a doctor or other health professional that they had coronary heart disease, angina (angina pectoris), or a heart attack (myocardial infarction).
- #30 Establishing a National Cardiovascular Disease Surveillance System in the United States Using Electronic Health Record Data: Key Strengths and Limitationshttps://pmc.ncbi.nlm.nih.gov/articles/PMC9238467/
Cardiovascular disease surveillance involves quantifying the evolving population-level burden of cardiovascular outcomes and risk factors as a data-driven initial step followed by the implementation of interventional strategies designed to alleviate this burden in the target population. […] Despite widespread acknowledgement of its potential value, a national surveillance system dedicated specifically to cardiovascular disease does not currently exist in the United States. […] Accordingly, this article elaborates on some key strengths and limitations of using EHR data for establishing a national cardiovascular disease surveillance system. […] Key strengths discussed include the: (1) ubiquity of EHRs and consequent ability to create a more national surveillance system, (2) existence of a common data infrastructure underlying the health care enterprise with respect to data domains and the nomenclature by which these data are expressed, (3) longitudinal length and detail that define EHR data when individuals repeatedly patronize a health care organization, and (4) breadth of outcomes capable of being surveilled with EHRs.
- #31 Establishing a National Cardiovascular Disease Surveillance System in the United States Using Electronic Health Record Data: Key Strengths and Limitationshttps://pmc.ncbi.nlm.nih.gov/articles/PMC9238467/
Cardiovascular disease surveillance involves quantifying the evolving population-level burden of cardiovascular outcomes and risk factors as a data-driven initial step followed by the implementation of interventional strategies designed to alleviate this burden in the target population. […] Despite widespread acknowledgement of its potential value, a national surveillance system dedicated specifically to cardiovascular disease does not currently exist in the United States. […] Accordingly, this article elaborates on some key strengths and limitations of using EHR data for establishing a national cardiovascular disease surveillance system. […] Key strengths discussed include the: (1) ubiquity of EHRs and consequent ability to create a more national surveillance system, (2) existence of a common data infrastructure underlying the health care enterprise with respect to data domains and the nomenclature by which these data are expressed, (3) longitudinal length and detail that define EHR data when individuals repeatedly patronize a health care organization, and (4) breadth of outcomes capable of being surveilled with EHRs.
- #32 Establishing a National Cardiovascular Disease Surveillance System in the United States Using Electronic Health Record Data: Key Strengths and Limitationshttps://pmc.ncbi.nlm.nih.gov/articles/PMC9238467/
Continuous surveillance efforts allow assessing the collective impact of applied interventions on the metrics they are designed to improve. […] The ideal national CVD surveillance system would cost-efficiently follow a large, representative set of US residents over extended periods while tracking a broad range of metrics such that a comprehensive picture of the nation’s cardiovascular health emerges. […] Several ongoing efforts provide valuable surveillance metrics related to CVD, many of which have been recently summarized. […] The recent proliferation of EHRs in the United States has generated enthusiasm for using EHR data for research, assessing quality improvement initiatives, and monitoring public health, including establishment of a national CVD surveillance system. […] EHR data also tend to represent broader patient populations than isolated claims data sources and are more available in real time.
- #33 Establishing a National Cardiovascular Disease Surveillance System in the United States Using Electronic Health Record Data: Key Strengths and Limitationshttps://pmc.ncbi.nlm.nih.gov/articles/PMC9238467/
Continuous surveillance efforts allow assessing the collective impact of applied interventions on the metrics they are designed to improve. […] The ideal national CVD surveillance system would cost-efficiently follow a large, representative set of US residents over extended periods while tracking a broad range of metrics such that a comprehensive picture of the nation’s cardiovascular health emerges. […] Several ongoing efforts provide valuable surveillance metrics related to CVD, many of which have been recently summarized. […] The recent proliferation of EHRs in the United States has generated enthusiasm for using EHR data for research, assessing quality improvement initiatives, and monitoring public health, including establishment of a national CVD surveillance system. […] EHR data also tend to represent broader patient populations than isolated claims data sources and are more available in real time.
- #34 Establishing a National Cardiovascular Disease Surveillance System in the United States Using Electronic Health Record Data: Key Strengths and Limitationshttps://pmc.ncbi.nlm.nih.gov/articles/PMC9238467/
Continuous surveillance efforts allow assessing the collective impact of applied interventions on the metrics they are designed to improve. […] The ideal national CVD surveillance system would cost-efficiently follow a large, representative set of US residents over extended periods while tracking a broad range of metrics such that a comprehensive picture of the nation’s cardiovascular health emerges. […] Several ongoing efforts provide valuable surveillance metrics related to CVD, many of which have been recently summarized. […] The recent proliferation of EHRs in the United States has generated enthusiasm for using EHR data for research, assessing quality improvement initiatives, and monitoring public health, including establishment of a national CVD surveillance system. […] EHR data also tend to represent broader patient populations than isolated claims data sources and are more available in real time.
- #35 Establishing a National Cardiovascular Disease Surveillance System in the United States Using Electronic Health Record Data: Key Strengths and Limitationshttps://pmc.ncbi.nlm.nih.gov/articles/PMC9238467/
Cardiovascular disease surveillance involves quantifying the evolving population-level burden of cardiovascular outcomes and risk factors as a data-driven initial step followed by the implementation of interventional strategies designed to alleviate this burden in the target population. […] Despite widespread acknowledgement of its potential value, a national surveillance system dedicated specifically to cardiovascular disease does not currently exist in the United States. […] Accordingly, this article elaborates on some key strengths and limitations of using EHR data for establishing a national cardiovascular disease surveillance system. […] Key strengths discussed include the: (1) ubiquity of EHRs and consequent ability to create a more national surveillance system, (2) existence of a common data infrastructure underlying the health care enterprise with respect to data domains and the nomenclature by which these data are expressed, (3) longitudinal length and detail that define EHR data when individuals repeatedly patronize a health care organization, and (4) breadth of outcomes capable of being surveilled with EHRs.
- #36 Establishing a National Cardiovascular Disease Surveillance System in the United States Using Electronic Health Record Data: Key Strengths and Limitationshttps://pmc.ncbi.nlm.nih.gov/articles/PMC9238467/
Cardiovascular disease surveillance involves quantifying the evolving population-level burden of cardiovascular outcomes and risk factors as a data-driven initial step followed by the implementation of interventional strategies designed to alleviate this burden in the target population. […] Despite widespread acknowledgement of its potential value, a national surveillance system dedicated specifically to cardiovascular disease does not currently exist in the United States. […] Accordingly, this article elaborates on some key strengths and limitations of using EHR data for establishing a national cardiovascular disease surveillance system. […] Key strengths discussed include the: (1) ubiquity of EHRs and consequent ability to create a more national surveillance system, (2) existence of a common data infrastructure underlying the health care enterprise with respect to data domains and the nomenclature by which these data are expressed, (3) longitudinal length and detail that define EHR data when individuals repeatedly patronize a health care organization, and (4) breadth of outcomes capable of being surveilled with EHRs.
- #37 Establishing a National Cardiovascular Disease Surveillance System in the United States Using Electronic Health Record Data: Key Strengths and Limitationshttps://pmc.ncbi.nlm.nih.gov/articles/PMC9238467/
Cardiovascular disease surveillance involves quantifying the evolving population-level burden of cardiovascular outcomes and risk factors as a data-driven initial step followed by the implementation of interventional strategies designed to alleviate this burden in the target population. […] Despite widespread acknowledgement of its potential value, a national surveillance system dedicated specifically to cardiovascular disease does not currently exist in the United States. […] Accordingly, this article elaborates on some key strengths and limitations of using EHR data for establishing a national cardiovascular disease surveillance system. […] Key strengths discussed include the: (1) ubiquity of EHRs and consequent ability to create a more national surveillance system, (2) existence of a common data infrastructure underlying the health care enterprise with respect to data domains and the nomenclature by which these data are expressed, (3) longitudinal length and detail that define EHR data when individuals repeatedly patronize a health care organization, and (4) breadth of outcomes capable of being surveilled with EHRs.
- #38 Establishing a National Cardiovascular Disease Surveillance System in the United States Using Electronic Health Record Data: Key Strengths and Limitationshttps://pmc.ncbi.nlm.nih.gov/articles/PMC9238467/
Cardiovascular disease surveillance involves quantifying the evolving population-level burden of cardiovascular outcomes and risk factors as a data-driven initial step followed by the implementation of interventional strategies designed to alleviate this burden in the target population. […] Despite widespread acknowledgement of its potential value, a national surveillance system dedicated specifically to cardiovascular disease does not currently exist in the United States. […] Accordingly, this article elaborates on some key strengths and limitations of using EHR data for establishing a national cardiovascular disease surveillance system. […] Key strengths discussed include the: (1) ubiquity of EHRs and consequent ability to create a more national surveillance system, (2) existence of a common data infrastructure underlying the health care enterprise with respect to data domains and the nomenclature by which these data are expressed, (3) longitudinal length and detail that define EHR data when individuals repeatedly patronize a health care organization, and (4) breadth of outcomes capable of being surveilled with EHRs.
- #39 Establishing a National Cardiovascular Disease Surveillance System in the United States Using Electronic Health Record Data: Key Strengths and Limitationshttps://pmc.ncbi.nlm.nih.gov/articles/PMC9238467/
Key limitations discussed include the: (1) incomplete ascertainment of health information related to health care-seeking behavior and the disconnect of health care data generated at separate health care organizations, (2) suspect data quality resulting from the default information-gathering processes within the clinical enterprise, (3) questionable ability to surveil patients through EHRs in the absence of documented interactions, and (4) the challenge in interpreting temporal trends in health metrics, which can be obscured by changing clinical and administrative processes. […] Despite multiple exhortations for a dedicated national CVD surveillance system over the past 15 years, such a system does not currently exist. […] Population-level surveillance of the appropriate metrics serves to quantify this burden at the national level and enables contrasts between metrics such that prioritizations can be made and impactful public health and/or clinical interventions can be planned and applied.
- #40 Establishing a National Cardiovascular Disease Surveillance System in the United States Using Electronic Health Record Data: Key Strengths and Limitationshttps://pmc.ncbi.nlm.nih.gov/articles/PMC9238467/
Key limitations discussed include the: (1) incomplete ascertainment of health information related to health care-seeking behavior and the disconnect of health care data generated at separate health care organizations, (2) suspect data quality resulting from the default information-gathering processes within the clinical enterprise, (3) questionable ability to surveil patients through EHRs in the absence of documented interactions, and (4) the challenge in interpreting temporal trends in health metrics, which can be obscured by changing clinical and administrative processes. […] Despite multiple exhortations for a dedicated national CVD surveillance system over the past 15 years, such a system does not currently exist. […] Population-level surveillance of the appropriate metrics serves to quantify this burden at the national level and enables contrasts between metrics such that prioritizations can be made and impactful public health and/or clinical interventions can be planned and applied.
- #41 Establishing a National Cardiovascular Disease Surveillance System in the United States Using Electronic Health Record Data: Key Strengths and Limitationshttps://pmc.ncbi.nlm.nih.gov/articles/PMC9238467/
Key limitations discussed include the: (1) incomplete ascertainment of health information related to health care-seeking behavior and the disconnect of health care data generated at separate health care organizations, (2) suspect data quality resulting from the default information-gathering processes within the clinical enterprise, (3) questionable ability to surveil patients through EHRs in the absence of documented interactions, and (4) the challenge in interpreting temporal trends in health metrics, which can be obscured by changing clinical and administrative processes. […] Despite multiple exhortations for a dedicated national CVD surveillance system over the past 15 years, such a system does not currently exist. […] Population-level surveillance of the appropriate metrics serves to quantify this burden at the national level and enables contrasts between metrics such that prioritizations can be made and impactful public health and/or clinical interventions can be planned and applied.
- #42 Establishing a National Cardiovascular Disease Surveillance System in the United States Using Electronic Health Record Data: Key Strengths and Limitationshttps://pmc.ncbi.nlm.nih.gov/articles/PMC9238467/
Key limitations discussed include the: (1) incomplete ascertainment of health information related to health care-seeking behavior and the disconnect of health care data generated at separate health care organizations, (2) suspect data quality resulting from the default information-gathering processes within the clinical enterprise, (3) questionable ability to surveil patients through EHRs in the absence of documented interactions, and (4) the challenge in interpreting temporal trends in health metrics, which can be obscured by changing clinical and administrative processes. […] Despite multiple exhortations for a dedicated national CVD surveillance system over the past 15 years, such a system does not currently exist. […] Population-level surveillance of the appropriate metrics serves to quantify this burden at the national level and enables contrasts between metrics such that prioritizations can be made and impactful public health and/or clinical interventions can be planned and applied.
- #43 2 Cardiovascular Disease | A Nationwide Framework for Surveillance of Cardiovascular and Chronic Lung Diseases | The National Academies Presshttps://nap.nationalacademies.org/read/13145/chapter/4
Epidemiological data on heart disease, stroke, and associated risk factors are compiled and published annually in the Heart Disease and Stroke Statistical Update. This publication is a collaborative effort of the American Heart Association (AHA), the Centers for Disease Control and Prevention, the National Institutes of Health, and other government agencies. This chapter draws from the most recent edition of the report, the Heart Disease and Stroke Statistics 2011 Update, in addition to other resources to provide an overview of the burden of cardiovascular diseases in the United States. […] The AHA reports that approximately 82.6 million people in the United States currently have one or more forms of cardiovascular disease (CVD), making it a leading cause of death for both men and women.
- #44 2 Cardiovascular Disease | A Nationwide Framework for Surveillance of Cardiovascular and Chronic Lung Diseases | The National Academies Presshttps://nap.nationalacademies.org/read/13145/chapter/4
Epidemiological data on heart disease, stroke, and associated risk factors are compiled and published annually in the Heart Disease and Stroke Statistical Update. This publication is a collaborative effort of the American Heart Association (AHA), the Centers for Disease Control and Prevention, the National Institutes of Health, and other government agencies. This chapter draws from the most recent edition of the report, the Heart Disease and Stroke Statistics 2011 Update, in addition to other resources to provide an overview of the burden of cardiovascular diseases in the United States. […] The AHA reports that approximately 82.6 million people in the United States currently have one or more forms of cardiovascular disease (CVD), making it a leading cause of death for both men and women.
- #45 2 Cardiovascular Disease | A Nationwide Framework for Surveillance of Cardiovascular and Chronic Lung Diseases | The National Academies Presshttps://nap.nationalacademies.org/read/13145/chapter/4
An estimated 16.3 million Americans aged 20 and older have CHD, a prevalence of 7 percent. […] The prevalence for men is 8.3 percent and for women is 6.1 percent. […] Non-Hispanic white men have the highest prevalence of CHD at 8.5 percent, followed by non-Hispanic black men at 7.9 percent and Mexican American men at 6.3 percent. […] For women, non-Hispanic black women have the highest rate of CHD at 7.6 percent, followed by non-Hispanic white women at 5.8 percent and Mexican American women at 5.6 percent. […] Data from the Strong Heart Study, funded by the National Heart, Lung, and Blood Institute (NHLBI), found that the incidence of CHD in American Indians between the ages of 45 and 74 was 17.9 per 1,000 person-years: 23.2 per 1,000 person-years in men and 14.8 in women. […] Cardiovascular diseases claimed 813,804 lives in 2007.
- #46 2 Cardiovascular Disease | A Nationwide Framework for Surveillance of Cardiovascular and Chronic Lung Diseases | The National Academies Presshttps://nap.nationalacademies.org/read/13145/chapter/4
Heart attacks were responsible for 132,968 deaths, and approximately 15 percent of those who have a heart attack will die from it, resulting in an average of 15 lost years of potential life. […] The annual incidence of sudden cardiac death is higher in men than women, but this difference begins to narrow with advancing age. […] Approximately 81 percent of individuals whose death is attributed to coronary heart disease are over age 65. […] Death rates from coronary heart disease decreased by 59 percent between 1950 and 1999, and decreased 26.3 percent between 1997 and 2007. […] The direct and indirect costs of cardiovascular diseases and stroke in the United States are estimated at more than $286 billion. […] Cardiovascular disease is multifactorial; some risk factors are modifiable, and some (age, heredity, and male sex) cannot be modified.
- #47 Health and productivity burden of coronary heart disease in the working Indonesian population using life-table modelling | BMJ Openhttps://bmjopen.bmj.com/content/10/9/e039221
The prevalence of CHD in the Indonesian population of working-age was 1.45% (1.3% in men and 1.6% in women), equating to almost 2.0 million people (865 855 men and 1.08 million women) aged between 15 and 55 years (retirement age). […] With simulated follow-up until retirement (age 55 years), the cohort with CHD was predicted to incur 32492 excess deaths (15387 among men and 17105 among women). Excess deaths attributable to CHD accounted for 36.6% of all deaths among Indonesians of working age. […] The findings of our study are not directly comparable to those of any other study because no other study has estimated the mortality and morbidity burden of CHD among Indonesians across the timeframe of working age. […] We estimated that among Indonesians aged 15-54 years who currently have CHD, US$33.3 billion would be lost in GDP by the time the cohort members all reach age 55 years. […] We assumed that each Indonesian of working age with CHD would incur US$5720 in healthcare costs per year. […] Our study provides important data that will help shape the Indonesian healthcare system as it continues to evolve.
- #48 Epidemiology of Coronary Heart Disease in the Elderly | Radiology Keyhttps://radiologykey.com/epidemiology-of-coronary-heart-disease-in-the-elderly/
The percentage of people aged 65 years and older in the United States is calculated to increase from 12.4 % (35 million) of the population in 2000 to 19.6 % (71 million) by 2030, with 82 million in that age group by 2050. […] Atherosclerosis as the driving force of coronary artery disease starts at early ages in life and is universally present in patients above 65 years old. […] The economic costs for the diagnosis and treatment of cardiovascular disease (including stroke) are estimated as high as 315 billions US-Dollar in 2014. […] This chapter about the epidemiology of coronary artery disease in the elderly focuses on the burden of the disease, on subclinical and clinical manifestations, on relevant risk factors for CAD in the elderly, and current available evidences with regard to the management in the primary and secondary prevention of CAD.
- #49 Coronary Artery Atherosclerosis: Practice Essentials, Background, Anatomyhttps://emedicine.medscape.com/article/153647-overview
The true frequency of atherosclerosis is difficult, if not impossible, to accurately determine because it is a predominantly asymptomatic condition. The process of atherosclerosis begins in childhood with the development of fatty streaks. These lesions can be found in the aorta shortly after birth and appear in increasing numbers in those aged 8-18 years. More advanced lesions begin to develop when individuals are aged approximately 25 years. Subsequently, an increasing prevalence of the advanced complicated lesions of atherosclerosis is noted, and the organ-specific clinical manifestations of the disease increase with age through the fifth and sixth decades of life. […] In the United States, approximately 14 million persons experience CAD and its various complications. Congestive heart failure (CHF) that develops because of ischemic cardiomyopathy in hypertensive MI survivors has become the most common discharge diagnosis for patients in American hospitals. Approximately 80 million people, or 36.3% of the population, have cardiovascular disease.
- #50 2 Cardiovascular Disease | A Nationwide Framework for Surveillance of Cardiovascular and Chronic Lung Diseases | The National Academies Presshttps://nap.nationalacademies.org/read/13145/chapter/4
The NHBPEP works to achieve the Healthy People 2010 objectives for heart disease and stroke prevention by developing and disseminating educational materials and programs, and fostering partnerships among program participants. […] The National Cholesterol Education Program (NCEP) was established by NHLBI in 1985 to reduce the percentage of Americans with high blood cholesterol and resulting coronary heart disease. […] The Obesity Education Initiative (OEI) was launched by NHLBI in 1991 to reduce the prevalence of overweight, obesity, and physical inactivity. […] The National Diabetes Education Program (NDEP) was established in 1997 and is funded by the National Institutes of Health and the CDC. […] The CDC’s Office on Smoking and Health (OSH) was established in 1965 to reduce the death and disease caused by tobacco use and exposure to secondhand smoke.
- #51 2 Cardiovascular Disease | A Nationwide Framework for Surveillance of Cardiovascular and Chronic Lung Diseases | The National Academies Presshttps://nap.nationalacademies.org/read/13145/chapter/4
The NHBPEP works to achieve the Healthy People 2010 objectives for heart disease and stroke prevention by developing and disseminating educational materials and programs, and fostering partnerships among program participants. […] The National Cholesterol Education Program (NCEP) was established by NHLBI in 1985 to reduce the percentage of Americans with high blood cholesterol and resulting coronary heart disease. […] The Obesity Education Initiative (OEI) was launched by NHLBI in 1991 to reduce the prevalence of overweight, obesity, and physical inactivity. […] The National Diabetes Education Program (NDEP) was established in 1997 and is funded by the National Institutes of Health and the CDC. […] The CDC’s Office on Smoking and Health (OSH) was established in 1965 to reduce the death and disease caused by tobacco use and exposure to secondhand smoke.
- #52 2 Cardiovascular Disease | A Nationwide Framework for Surveillance of Cardiovascular and Chronic Lung Diseases | The National Academies Presshttps://nap.nationalacademies.org/read/13145/chapter/4
The NHBPEP works to achieve the Healthy People 2010 objectives for heart disease and stroke prevention by developing and disseminating educational materials and programs, and fostering partnerships among program participants. […] The National Cholesterol Education Program (NCEP) was established by NHLBI in 1985 to reduce the percentage of Americans with high blood cholesterol and resulting coronary heart disease. […] The Obesity Education Initiative (OEI) was launched by NHLBI in 1991 to reduce the prevalence of overweight, obesity, and physical inactivity. […] The National Diabetes Education Program (NDEP) was established in 1997 and is funded by the National Institutes of Health and the CDC. […] The CDC’s Office on Smoking and Health (OSH) was established in 1965 to reduce the death and disease caused by tobacco use and exposure to secondhand smoke.
- #53 2 Cardiovascular Disease | A Nationwide Framework for Surveillance of Cardiovascular and Chronic Lung Diseases | The National Academies Presshttps://nap.nationalacademies.org/read/13145/chapter/4
The NHBPEP works to achieve the Healthy People 2010 objectives for heart disease and stroke prevention by developing and disseminating educational materials and programs, and fostering partnerships among program participants. […] The National Cholesterol Education Program (NCEP) was established by NHLBI in 1985 to reduce the percentage of Americans with high blood cholesterol and resulting coronary heart disease. […] The Obesity Education Initiative (OEI) was launched by NHLBI in 1991 to reduce the prevalence of overweight, obesity, and physical inactivity. […] The National Diabetes Education Program (NDEP) was established in 1997 and is funded by the National Institutes of Health and the CDC. […] The CDC’s Office on Smoking and Health (OSH) was established in 1965 to reduce the death and disease caused by tobacco use and exposure to secondhand smoke.
- #54 Explore Cardiovascular Diseases in the United States | AHRhttps://www.americashealthrankings.org/explore/measures/CVD/CVD_civilian
Between 1980 and 2000, the death rate from coronary heart disease halved; 47% of this decrease was because of medical interventions like coronary artery bypass and statin therapy. […] Healthy People 2030 provides several objectives related to improving cardiac health, including: Improving cardiovascular health among adults, Reducing coronary heart disease deaths, Reducing stroke deaths, Increasing control of blood pressure in adults, Increasing cholesterol treatment in adults. […] Additionally, the Million Hearts 2027 initiative is a national effort to prevent 1 million heart attacks and strokes in five years by promoting community and clinical prevention programs.
- #55 Explore Cardiovascular Diseases in the United States | AHRhttps://www.americashealthrankings.org/explore/measures/CVD/CVD_civilian
Between 1980 and 2000, the death rate from coronary heart disease halved; 47% of this decrease was because of medical interventions like coronary artery bypass and statin therapy. […] Healthy People 2030 provides several objectives related to improving cardiac health, including: Improving cardiovascular health among adults, Reducing coronary heart disease deaths, Reducing stroke deaths, Increasing control of blood pressure in adults, Increasing cholesterol treatment in adults. […] Additionally, the Million Hearts 2027 initiative is a national effort to prevent 1 million heart attacks and strokes in five years by promoting community and clinical prevention programs.
- #56https://www.who.int/news-room/fact-sheets/detail/cardiovascular-diseases-(cvds)
Cardiovascular diseases (CVDs) are a group of disorders of the heart and blood vessels. They include: […] coronary heart disease a disease of the blood vessels supplying the heart muscle; […] Evidence from 18 countries has shown that hypertension programmes can be implemented efficiently and cost-effectively at the primary care level which will ultimately result in reduced coronary heart disease and stroke. […] In addition, target 9 states that there should be 80% availability of the affordable basic technologies and essential medicines, including generics, required to treat major NCDs in both public and private facilities. […] WHO is currently working on increasing the normative guidance available for the management of acute coronary syndrome and stroke which will provide guidance in these important areas.
- #57https://www.who.int/news-room/fact-sheets/detail/cardiovascular-diseases-(cvds)
Cardiovascular diseases (CVDs) are a group of disorders of the heart and blood vessels. They include: […] coronary heart disease a disease of the blood vessels supplying the heart muscle; […] Evidence from 18 countries has shown that hypertension programmes can be implemented efficiently and cost-effectively at the primary care level which will ultimately result in reduced coronary heart disease and stroke. […] In addition, target 9 states that there should be 80% availability of the affordable basic technologies and essential medicines, including generics, required to treat major NCDs in both public and private facilities. […] WHO is currently working on increasing the normative guidance available for the management of acute coronary syndrome and stroke which will provide guidance in these important areas.
- #58 Epidemiology and the Magnitude of Coronary Artery Disease and Acute Coronary Syndrome: A Narrative Review | Atlantis Presshttps://www.atlantis-press.com/journals/jegh/125950929/view
Even though CAD mortality and prevalence vary among countries it is the top cause of death in countries of all income groups. Estimation of the true prevalence of CAD in the population is complex. […] The progressive decrease in mortality from CAD in developed countries over the recent few decades may be due to both effective treatment for the acute phase and improved primary and secondary preventive measures. However, ethnic difference, social inequalities, and difference in availability of effective treatment and preventive measures in different regions of the same country may affect overall outcome and this needs more studies and evaluation of different regions within the country. […] Mortality from non-communicable diseases including CAD is expected to rise in the coming decades due to worsening of metabolic risk factors. Hence, the reduction in the CAD burden will require changes at both the policy as well as at the individual levels. Stake holders should target these risk factors through public health policies and this may be the best way to interrupt this trend.
- #59 The Epidemiology of Coronary Heart Disease – Revista Española de CardiologÃa (English Edition)https://www.revespcardiol.org/en-the-epidemiology-coronary-heart-disease-articulo-S1885585713003381
This study also calculated a marked expected increase in the incidence of ACS during the next 35 to 40 years, paralleling population aging. […] The mortality rates from cardiovascular disease in general and from ischemic heart disease in particular, in men and women as well as in blacks and whites, have fallen between 24% and 50% in developed countries since 1975, although the decrease has been slower since 1990. […] In the United States, mortality from cardiovascular disease decreased by 29% from 1996 to 2006. […] In Spain, recent estimates of the trends in the rate of mortality from myocardial infarction have been compared with those of the United States; a more pronounced relative decrease has been seen in the mortality rate in the United States, so that depending on the model, the expected rate of mortality would be lower in the United States than in Spain from 2008 in men and 2012 in women. […] Although the incidence of CHD continues to decrease in developed countries, immigration and progressive population aging suggest that the absolute number of coronary events and, consequently, the prevalence of CHD will not decrease and may even increase in the near future.
- #60https://link.springer.com/article/10.2991/jegh.k.201217.001
CAD mortality and prevalence vary among countries. Estimation of the true prevalence of CAD in the population is complex. A significant number of countries have not provided data, the estimation of the exact figures for epidemiological data is a barrier. The incidence of CAD continues to fall in developed countries over the last few decades and this may be due to both effective treatment of the acute phase and improved primary and secondary preventive measures. Developing countries show considerable variability in the incidence of CAD. The globalization of the Western diet and increased sedentary lifestyle will have a dramatic influence on the progressive increase in the incidence of CAD in these countries.
- #61 Epidemiology and the Magnitude of Coronary Artery Disease and Acute Coronary Syndrome: A Narrative Review | Atlantis Presshttps://www.atlantis-press.com/journals/jegh/125950929/view
Coronary artery disease is the foremost single cause of mortality and loss of Disability Adjusted Life Years (DALYs) globally. A large number of this burden falls on low and middle income countries accounting for nearly 7 million deaths and 129 million DALYs annually. […] The incidence of CAD continues to fall in developed countries over the last few decades and this may be due to both effective treatment of the acute phase and improved primary and secondary preventive measures. Developing countries show considerable variability in the incidence of CAD. […] The globalization of the Western diet and increased sedentary lifestyle will have a dramatic influence on the progressive increase in the incidence of CAD in these countries. […] The INTERHEART study showed that there were potentially modifiable risk factors for ACS including raised Apo B/Apo A ratio, current smoking status, psychosocial factors, diabetes, hypertension, abdominal obesity, alcohol consumption, regular physical activity and daily consumption of fruits and vegetables.
- #62 Epidemiology and the Magnitude of Coronary Artery Disease and Acute Coronary Syndrome: A Narrative Review | Atlantis Presshttps://www.atlantis-press.com/journals/jegh/125950929/view
Even though CAD mortality and prevalence vary among countries it is the top cause of death in countries of all income groups. Estimation of the true prevalence of CAD in the population is complex. […] The progressive decrease in mortality from CAD in developed countries over the recent few decades may be due to both effective treatment for the acute phase and improved primary and secondary preventive measures. However, ethnic difference, social inequalities, and difference in availability of effective treatment and preventive measures in different regions of the same country may affect overall outcome and this needs more studies and evaluation of different regions within the country. […] Mortality from non-communicable diseases including CAD is expected to rise in the coming decades due to worsening of metabolic risk factors. Hence, the reduction in the CAD burden will require changes at both the policy as well as at the individual levels. Stake holders should target these risk factors through public health policies and this may be the best way to interrupt this trend.
- #63 Epidemiology of coronary artery disease and stroke and associated risk factors in Gaza community âPalestine | PLOS Onehttps://journals.plos.org/plosone/article?id=10.1371/journal.pone.0211131
The most common condition was coronary artery disease (8.3%), followed by stroke events (3%). The associated risk factors were obesity (47.8%), hypertension (28.4%), current smoking account for (23.2%), diabetes mellitus (19.1%), high cholesterol level (8.8%), and high triglycerides level (40.2%). […] The burden of CVDs and their associated risk factors is considerable in Gaza and represents a major public health concern. Effective strategies in management, education and healthcare centers are required for an accurate management and implementation of preventive measure in this area. […] Our study is the first to report the prevalence of CVDs among Gazans in Palestine. Previous surveys were hospital based or on United Nation Relief and Work Agency (UNRWA) report. The prevalence of CVDs nears 10% of the population above the age of 25 years in this area.
- #64 Epidemiology and the Magnitude of Coronary Artery Disease and Acute Coronary Syndrome: A Narrative Review | Atlantis Presshttps://www.atlantis-press.com/journals/jegh/125950929/view
Even though CAD mortality and prevalence vary among countries it is the top cause of death in countries of all income groups. Estimation of the true prevalence of CAD in the population is complex. […] The progressive decrease in mortality from CAD in developed countries over the recent few decades may be due to both effective treatment for the acute phase and improved primary and secondary preventive measures. However, ethnic difference, social inequalities, and difference in availability of effective treatment and preventive measures in different regions of the same country may affect overall outcome and this needs more studies and evaluation of different regions within the country. […] Mortality from non-communicable diseases including CAD is expected to rise in the coming decades due to worsening of metabolic risk factors. Hence, the reduction in the CAD burden will require changes at both the policy as well as at the individual levels. Stake holders should target these risk factors through public health policies and this may be the best way to interrupt this trend.