In a recent study published in BMJ, researchers investigated the overall incidence of cardiovascular disease (CVD) in the United Kingdom from 2000 to 2019.
Background
The introduction of statins and public health initiatives have improved the prevention of heart disease since the 1970s. Recent research, however, indicates that the prevalence of heart disease may be rising among younger individuals and that the burden of cardiovascular disease has plateaued in high-income nations.
Though socioeconomic deprivation is not as tightly linked to other cardiovascular disorders as atherosclerosis is to atherosclerosis, it is nonetheless crucial to understand since socioeconomic inequality is rising in several nations. Extensive epidemiological research is required to investigate secular patterns, focus on preventative initiatives, draw attention to clinical trials, and pinpoint medical resources for handling new issues.
About the study
In the present observational study, researchers examined CVD incidence trends among UK residents between 2000 and 2019.
The researchers used anonymized electronic medical records from the AURUM and GOLD Clinical Practice Research Datalink (CPRD) datasets. They analyzed CPRD records that linked primary care data to the Hospital Episodes Statistics (HES) secondary care data and the Office for National Statistics (ONS) death records.
The researchers included 1,650,052 UK residents with incident CVD diagnoses and general practice registrations contributing to CPRD between January 1, 2000, and June 30, 2019. They used the International Classification of Diseases, ninth version (ICD-9) and ICD-10 codes, the United Kingdom Office of Population Censuses and Surveys (OPCS-4) classification, SNOMED, EMIS, and Read codes to diagnose CVD. They excluded individuals diagnosed with CVD before study initiation or within a year after enrolling with their general practitioner.
CVDs included atrial fibrillation, acute coronary syndromes, aortic stenosis, aortic aneurysm, heart failure, second-third-degree cardiac blockages, chronic ischemic heart disease, peripheral arterial diseases, venous thromboembolism, and stroke. Thromboembolism cases included pulmonary embolism and deep vein thrombosis (DVT), and stroke cases included hemorrhagic and ischemic stroke.
The researchers used the 2015 Index of Multiple Deprivation (IMD) to assess socioeconomic status. They calculated individual and cumulative CVD incidences using data standardized for the European population in 2013. They used negative binomial regressions to calculate the incidence rate ratios (IRR) for analysis, adjusting for smoking status, blood pressure, body mass index (BMI), and cholesterol. They used the Index of Multiple Deprivation (IMD) 2015 to determine participant socioeconomic levels.
Results
The average participant age was 71 years; 48% were female. The sex- and age-standardized CVD incidence rates decreased by 19% between 2000 and 2019 (IRR for 2017–2019 vs. 2000–2002: 0.8). Stroke and coronary artery disease incidence declined by 30% (IRR for stroke, chronic ischemic heart diseases, and acute coronary syndromes were 0.8, 0.7, and 0.7, respectively). Correspondingly, the team noted rising cases of valve disease, thromboembolic diseases, and cardiac arrhythmias. Consequentially, the overall CVD incidence remained relatively similar mid-2000 period onward.
Age-stratified assessments showed a reduction in coronary artery disease incidence among individuals above 60 years of age, with negligible improvement among younger individuals. Trends remained similar for both sexes, with crude CVD incidence rates (per 100,000 individual years) of 1,069 and 1,176 for males and females, respectively.
The socioeconomic gradient noted for almost all cardiovascular diseases did not reduce with time. It showed profound results for peripheral arterial diseases (IRR for most deprived vs. least deprived: 2.0), acute coronary syndromes (IRR, 1.6), and cardiac failure (IRR, 1.5).
The team discovered a higher overall CVD incidence in North England. Sensitivity studies using broader illness categories, diagnoses documented on death certificates, longer lookback periods, or limiting diagnoses recorded during hospital stays yielded comparable results.
After a first CVD diagnosis, the proportion of patients taking statins and antihypertensive medications rose, but the usage of non-dihydropyridine calcium channel blockers, nitrates, and diuretics declined with time. Non-vitamin K antagonist oral anticoagulants have gradually supplanted vitamin K anticoagulants.
Conclusion
The study found that, despite considerable advances in atherosclerotic disease prevention in the United Kingdom, the total CVD burden among 22 million individuals remained high from 2000 to 2019. While cardiovascular stroke and ischemic heart disease incidences decreased, valve disease, thromboembolic events, and cardiac arrhythmias increased. Heart block and venous thromboembolism make significant contributions to the CVD burden.
Improvements in coronary heart disease rates primarily benefit individuals aged above 60 years. Future preventative initiatives should consider a broader range of illnesses and the unique requirements of younger age groups and socioeconomically disadvantaged individuals.
