Epidemiology

Cardiovascular disease is the single largest cause of death worldwide and is commonly associated with myocardial infarction.1

According to the WHO, 17.3 million deaths in 2008 were attributable to cardiovascular disease, with 7.3 million (42% of all cardiovascular deaths) being due the result of a myocardial infarction.1

In 2009, approximately 1 in 6 deaths in the United States was attributable to coronary heart disease.2

Major causes of death including cardiovascular disease1

Major causes of death including cardiovascular disease WHO estimate of deaths in 2011

Mortality rate: difference between countries

Heart disease mortality rates are affected by differences between countries in the major risk factors: blood pressure, blood cholesterol, smoking, lack of physical activity and poor diet. While genetic factors also play a part, approximately 80% of cardiovascular disease is due to one or more risk factors that are influenced by lifestyle.3

Deaths (x 1000) from ischaemic heart disease in WHO regions (estimates for 2008)

Deaths  from  ischaemic  heart  disease  in  WHO  regions 1 WHO estimate of death due to ischaemic heart disease for 2008

Coronary heart disease and resulting death rates are decreasing in many developed countries, especially North America and western European countries. This decrease is the result of improved prevention, diagnosis and treatment, particularly reductions in cigarette smoking, blood cholesterol and blood pressures.1,2

Trends in mortality rates from cardiovascular disease in developed countries3

Trends  in  mortality  rates  from  cardiovascular  disease  in  developed  countries Line diagram showing decrease in coronary heart disease and resulting death rates in developed countries

In particular, a large, population-based study in the US showed a significant decrease in the incidence of myocardial infarction and especially in ST-segment elevation myocardial infarction (STEMI) from 1999 to 2008.5

In developing and transitional countries, coronary heart disease is increasing, partly as a result of increasing longevity, urbanisation, and lifestyle changes. More than 60% of the global burden of coronary heart disease occurs in developing countries.1

A 30-year registry in Japan has also shown an increase in the incidence of myocardial infarction, probably as a result of increasing longevity of the population, a high rate of smoking and an increasingly more westernised lifestyle.6

Worldwide, data show that men are more likely than women to have an acute myocardial infarction (AMI) and that the risk of having an AMI increases with age.1

Deaths due to cardiovascular disease, according to gender1

Deaths  due  to  cardiovascular  disease  according  to  gender  Gender differences in mortality due to cardiovascular diseases, WHO analysis in 2011

For people aged over 60 years, coronary heart disease is the most likely cause of death worldwide and the incidence of acute myocardial infarction increases in both sexes with age, although this is more marked in men than in women.1,7

Prevalence of acute myocardial infarction, according to age and sex (US data 1999-2008)

Prevalence  of  acute  myocardial  infarction  according  to  age  and  sex   Data analysis for years 1999-2008 in US

Cardiovascular disease is responsible for 10% of the disability-adjusted life years (DALYs) lost in low- and middle-income countries and 18% of DALYs lost in high-income countries (DALYs combine years of potential life lost due to premature death with years of productive life lost due to disability, thus indicating the total burden of the disease).1

Distribution of global CVD burden (DALYs) due to cardiovascular diseases in men and women

Distribution  of  global  CVD  burden  due  to  cardiovascular  diseases  in  men  and  women          WHO report on global prevention and control of cardiovascular diseases, 2011

Over the next decades, the worldwide burden of disease is predicted to increase for cardiovascular disease, whilst infective diseases are likely to present a decreased burden.1

Changing worldwide burden of disease*, as % of total DALYs, in 2004 and predicted for 2030

Changing  worldwide  burden  of  disease  as  percent  of  total  DALYs  in  2004  and  predicted  for 2030 WHO prediction on global burden of prevalent diseases in 2030 in comparison to 2004

The total direct and indirect costs of CVD and stroke in the United States for 2009 were estimated at $312.6 billion. This includes heart disease, stroke, hypertensive disease and other circulatory conditions.2

Heart disease alone in the US in 2009 cost a total of $195.2 billion:2

 

  • $99.2 billion in direct costs (emergency room, inpatient care, home healthcare, and prescriptions).2
  • $96.0 billion in indirect costs (loss of productivity, resulting from morbidity and mortality).2
  • By comparison, in 2010 the estimated cost of all cancers in the United States was $124.57 billion.9

 

Direct and indirect costs of cardiovascular disease and stroke, United States 2009.

Direct  and  indirect  costs  of  cardiovascular  disease  and  stroke  United  states  2009   Costs of CVD management in US

In the EU, the estimated total cost for all cardiovascular disease is €196 billion/year, with 54% of this due to healthcare costs, 24% to loss of productivity and 22% to informal care of people with cardiovascular disease.10

References: 
  1. Mendis S, Puska P, Norrving B, editors. Global Atlas on Cardiovascular Disease Prevention and Control. World Health Organization, Geneva 2011.
  2. Go AS, et al, on behalf of the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Heart disease and stroke statistics – 2013 update: A report from the American Heart Association. Circulation 2013;127:e6-e245.
  3. WHO. Cardiovascular diseases (CVDs) Fact sheet No. 317. September 2012. Accessed 14.2.2013 at: http://www.who.int/mediacentre/factsheets/fs317/en/index.html
  4. WHO. Causes of Death 2008 Summary Tables, 2011. http://www.who.int/evidence/bod
  5. Yeh RW, et al. Population trends in the incidence and outcomes of acute myocardial infarction. N Engl J Med 2010;362:2155-2165.
  6. Takii T, et al. Trends in acute myocardial infarction incidence and mortality over 30 years in Japan: Report from the MIYAGI-AMI registry study. Circ J 2010;74:93-100.
  7. National Institutes of Health, National Heart, Lung and Blood Institute, 2012. Morbidity and mortality: 2012 chart book on cardiovascular, lung, and blood diseases.
  8. Roger VL, et al, on behalf of the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Heart disease and stroke statistics - 2012 update: a report from the American Heart Association. Circulation 2012;125:e2-e220.
  9. Mariotto AB, Yabroff KR, Shao Y, Feuer EJ, and Brown ML. Projections of the Cost of Cancer Care in the United States: 2010-2020. J Natl Cancer Inst 2011;103:117-128.
  10. Nichols M, Townsend N, Luengo-Fernandez R, Leal J, Gray A, Scarborough P, Rayner M (2012). European Cardiovascular Disease Statistics 2012. European Heart Network, Brussels, European Society of Cardiology, Sophia Antipolis.
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