Cardiovascular Disease: Epidemiology & Stats

Did you know that cardiovascular disease (CVD) is the leading cause of death, both in the US and in the world?

In this post, the following definitions will be used:

  • CVD: Coronary heart disease (CHD), heart failure (HF), stroke, and hypertension
  • ASCVD: Atherosclerotic Cardiovascular Disease. Comprised of CHD, ischemic stroke, and peripheral arterial disease
  • LDL-C: Low-Density Lipoprotein Cholesterol
  • MI: Myocardial infarction
  • AHA: American Heart Association

National Prevalence & Mortality

The National Health and Nutrition Examination Survey estimated that between 2015-20181:

  • The United States prevalence of CVD in adults ≥20 years of age was 126.9M
  • In 2018 alone, CVD accounted for 868,662 deaths in the US
    • Coronary heart disease (CHD) is the leading cause of CVD deaths

Between 2015 and 2020, the annual # of deaths due to Heart Disease and Stroke has increased consistently2:

Global Mortality:

  • Over 75% of CVD deaths take place in low- and middle-income countries1,3
  • In 2019, ~17.9M deaths were attributed to CVD (32% of all global deaths)1,3
  • Ischemic Heart Disease in 20191
    • Prevalence: 197.2M
    • Mortality: 9.1M

Challenges of Reaching Health Goals

A common biomarker used to determine the efficacy of lipid-lowering therapies (LLTs) is low-density lipoprotein cholesterol (LDL-C). Most patients have a goal of <70 mg/dL

In theory: ~99% of ASCVD patients could reach an LDL-C <70 mg/dL

In real-world practice: only ~25% reach that goal4

One of the greatest challenges to meeting CVD health goals is the lack of adherence to LLTs.

In a study assessing medication adherence and its effects on CV outcomes, patients were stratified as fully adherent, partially adherent, or non-adherent to their LLTs5

Results from 4,015 patients showed that after a recent MI:

  • 43% of patients were fully adherent
  • 31% were partially adherent
  • 26% were non-adherent

Patients who were fully adherent were less likely to have subsequent major adverse cardiovascular events compared to those who were non-adherent (hazard ratio: 0.73; p = 0.0004)5

Projection of CVD prevalence and associated cost by 2035

The estimated prevalence and the accompanying costs should serve as a warning that our healthcare systems needs to place more emphasis on preventing CVD.

LLTs have proven to be effective, but only when patients are adherent to them.

Although we have medications to reduce CVD risk, the best approach is to prevent CVD in the first place through healthy diet and lifestyle.

References

  1. Virani, S., Alonso, A., Benjamin, EJ. et al. Heart disease and stroke statistics—2020 update: a report from the American Heart Association.” Circulation (2020): E139-E596.
  2. Ahmad, F., Anderson, RN. The Leading Causes of Death in the US for 2020. JAMA. 2021;325(18): 1829-1830.
  3. Cardiovascular diseases: Key facts. World Health Organization website. https://www.who.int/en/news-room/fact-sheets/detail/cardiovascular-diseases-(cvds). Accessed Aug 2, 2021.
  4. Cannon CP, Khan I, Klimchak AC, Reynolds MR, Sanchez RJ, Sasiela WJ. Simulation of Lipid-Lowering Therapy Intensification in a Population With Atherosclerotic Cardiovascular Disease. JAMA Cardiol. 2017;2(9):959-966. doi:10.1001/jamacardio.2017.2289
  5. Bansilal S, Castellano JM, Garrido E, et al. Assessing the Impact of Medication Adherence on Long-Term Cardiovascular Outcomes. J Am Coll Cardiol. 2016;68(8):789-801. doi:10.1016/j.jacc.2016.06.005