Coronary heart disease

Heart disease is the predominant cause of death in all industrialised nations, accounting for 40% of all mortality.

Ischaemic heart disease is the single biggest contributor to cardiac mortality.

Reduction in coronary blood flow is the cause of myocardial ischaemia in over 90% of cases.

The arterial supply of the heart is unique because blood flow is confined to diastole - the coronary arteries being compressed during systole. There is considerable overlap in the distribution of the individual coronary arteries and, in disease, collateral flow may develop.

Coronary artery disease which may or may not lead to ischaemia also includes coronary artery aneurysm.

Global data from 1990-2019 suggests (1):

Ischemic Heart Disease (IHD)

• The prevalence of IHD in 2019 increased to 197 million cases (95% UI: 178-220 million).
• IHD mortality increased to 9.14 million (95% UI: 8.40-9.74 million) in 2019.
• In 2019, the number of DALYs reached 182 million (95% UI: 170-194 million).
• Age-standardized rates of DALYs due to IHD were substantially higher in men compared to women with a steep incline in cases beginning around the age of 30. Men between 45-49 years experienced as many DALYs as women aged 65-69 years.
• The age-standardized DALYs among men were highest in Central Asia, Eastern Europe, Oceania, and North Africa and the Middle East. The lowest age-standardized rates of DALYs were observed in high-income Asia Pacific, Australasia, Western Europe, and Andean Latin America.
• Among women, age-standardized DALYs were highest in Central Asia, Eastern Europe, Oceania, North Africa and the Middle East, and lowest in high-income Asia Pacific, Australasia, and Western Europe.

Reference:

• Roth GA et al. Global Burden of Cardiovascular Diseases and Risk Factors, 1990-2019: Update From the GBD 2019 Study.J Am Coll Cardiol. 2020;76:2982-3021. doi: 10.1016/j.jacc.2020.11.010.