Incidence of cardiovascular diseases over the past 20 years - a population-based study in 22 million individuals

Abstract

Abstract Background The incidence of atherosclerotic diseases has declined considerably since the early 2000s but the extent to which these reductions have occurred in different subgroups of patients is unknown. Whether there have been similar changes in the incidence of other cardiovascular diseases is also uncertain. Methods We used linked primary and secondary electronic health records of 22 million individuals from the Clinical Practice Research Datalink (CPRD), a cohort that is representative of the UK population in terms of age and sex. We calculated the incidence of 10 cardiovascular diseases from 2000 to 2019 and used Poisson regression models to investigate temporal trends and variation by age, sex, and socioeconomic status. Findings: Among the 22 009 375 individuals included in the study, we identified a total of 2 015 280 patients with a new diagnosis of at least one cardiovascular disease between 2000 and 2019 (mean (SD) age: 68.7 (16.8) years, 49% women). Collectively, the incidence of all 10 cardiovascular disorders (standardised by age and sex) decreased by 8% over the study period (incidence rate ratio (IRR) comparing 2017-2019 vs 2000-2002: 0.92 [0.92, 0.93]). The incidence of ischaemic heart disease and stroke decreased by about 30% over the study period (IRR comparing 2017-2019 vs 2000-2002: 0.72 [0.72, 0.73] and 0.73 [0.72, 0.74] for ischaemic heart disease and stroke, respectively), yet these improvements were largely restricted to older age groups and no improvements were observed in the incidence of atherosclerotic disease before the age of 60 years. The reductions in atherosclerotic diseases were also paralleled by a rising number of diagnoses of cardiac arrhythmias, valve disease, and thromboembolic diseases, which increased considerably over the 20 years studied (Figure 1). Most cardiovascular disorders were more common in men than in women of the same age. However, the overall crude incidence of cardiovascular diseases was similar in men and women, due to the higher number of women in older age groups. A socioeconomic gradient was evident across all cardiovascular diseases, did not decrease over time, and was most important for peripheral arterial disease (IRR most deprived compared to least deprived: 1.56 [1.55, 1.58]), heart failure (1.50 [1.49, 1.51]) and ischaemic heart disease (1.48 [1.48, 1.49]) (Figure 2). Interpretation: Despite important improvements in the prevention of atherosclerotic diseases, the overall burden of cardiovascular diseases remains very high. Further improvements in cardiovascular disease prevention may need to consider the broader spectrum of cardiovascular diseases, such as arrhythmia, valve diseases, and thromboembolic diseases, and examine the specific needs of younger age groups and socioeconomically deprived populations.Figure 1Figure 2