Decline in UK coronary heart disease rates offset by rise in other cardiovascular conditions

Rates of coronary heart disease in the UK have declined by about 30% over the past two decades, but this has been offset by rising rates of other conditions affecting the heart or blood vessels, finds a study in The BMJ today.

What’s more, improvements in rates of coronary heart disease almost exclusively appeared to benefit the over-60s, with little or no improvement in younger or more deprived groups, the results show. As such, the researchers say future prevention strategies might need to consider a broader spectrum of conditions, and examine the specific needs of younger age groups and socioeconomically deprived populations.

Since the 1970s, heart disease prevention has improved considerably, mainly due to efforts to control risk factors, such as anti-smoking laws and widespread use of drugs such as statins. Improvements in heart disease deaths have, however, stalled in several high income countries, and reports suggest that rates of heart disease might even be increasing among younger people.

To explore this further, researchers assessed trends for 10 common cardiovascular diseases (CVDs) in the UK from 2000 to 2019, and how these differed by age, sex, and socioeconomic status. Their findings are based on electronic health data and death registry records for just over 1.6 million individuals (average age 71; 48% women) with at least one newly diagnosed CVD during 2000-19.

The 10 CVDs assessed were acute coronary syndrome; aortic aneurysm; aortic stenosis; atrial fibrillation and flutter; chronic ischemic heart disease; heart failure; peripheral arterial disease; heart block; stroke; and venous thromboembolism.

Rates of all 10 CVDs declined by 19% during 2000-19 and rates of coronary heart disease and stroke decreased by about 30%. In parallel, an increasing number of diagnoses of abnormal heart rhythm (arrhythmias), valve disease, and blood clots (thromboembolic diseases) were seen. As a result, overall rates of CVDs across the 10 conditions remained relatively stable from the mid-2000s and trends were generally similar between men and women.

Further analyses showed that the decline in coronary heart disease was largely restricted to age groups older than 60 years, with little or no improvement in younger age groups. A socioeconomic gradient was also seen for almost every CVD investigated, with the most deprived groups having higher CVD rates compared with the least deprived.

The gradient did not decrease over time and was most noticeable for peripheral artery disease (almost twice as high in the most deprived group), acute coronary syndrome and heart failure (about 50% higher in the most deprived group).

Higher rates of all 10 conditions were also seen in northern regions (North West, North East, Yorkshire and The Humber) of England compared with London, even after adjusting for socioeconomic status. However, the authors note that geographical variations remained modest and did not appear to change considerably over time.

This is an observational study so no firm conclusions can be drawn about cause and effect, and the authors acknowledge that limitations of health record data, the lack of additional variables potentially relevant to CVD development, and the modest diversity in ethnic backgrounds, may have influenced their results.

Nevertheless, this was a large, representative study covering a broad spectrum of conditions over a 20-year period, and results were similar after further analyses, providing greater confidence in the conclusions.

As such, the authors say, “Despite substantial improvements in the prevention of atherosclerotic diseases in the UK, the overall burden of CVDs remained high during 2000-19. For CVDs to decrease further, future prevention strategies might need to consider a broader spectrum of conditions, including arrhythmias, valve diseases, and thromboembolism, and examine the specific needs of younger age groups and socioeconomically deprived populations.”