Chronic stable angina epidemiology


 * Associate Editor-In-Chief: Varun Kumar, M.B.B.S.

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

Developed countries

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

Developing countries

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

Age

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

The Impact of Gender

 * The onset of coronary artery disease in women follows that of men by about 10 years.
 * The incidence of CAD is greater in males when compared to premenopausal women. However, the incidence increases in postmenopausal women.
 * During 26 years of follow-up in the Framingham Heart Study, 80% of women under 75 years of age presented with angina pectoris rather than myocardial infraction. In contrast, only 20% of men presented with angina pectoris as their first manifestation of coronary artery disease.