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Is the prevalence of coronary heart disease falling in British men?
F C Lampe1, R W Morris, P H Whincup
1Cardiovascular Research Unit, Department of Primary Care and Population Sciences, Royal Free and UCL Medical School, Royal Free Campus, Rowland Hill Street, London NW3 2PF, UK. f.lampe@pcps.ucl.ac.uk
Insights
Middle-aged British men experience fewer angina symptoms, but diagnosed coronary heart disease (CHD) prevalence remains stable. Declining CHD event rates do not reduce the ongoing need for secondary prevention in this population.
Area of Science:
- Cardiology
- Epidemiology
- Public Health
Background:
- Coronary heart disease (CHD) is a major public health concern, particularly in middle-aged men.
- Understanding long-term trends in CHD event rates and prevalence is crucial for effective public health strategies.
- Previous decades have seen significant efforts in CHD prevention and management.
Purpose of the Study:
- To investigate the relationship between long-term trends in acute coronary heart disease (CHD) event rates and the burden of prevalent CHD in British men.
- To analyze changes in angina symptoms and diagnosed CHD history over time.
- To compare trends in CHD prevalence with CHD event rates.
Main Methods:
- A longitudinal cohort study involving 7735 British men, aged 40-59 at baseline (1978-80).
- Data on angina symptoms and diagnosed CHD history were collected via questionnaire in 1978-80, 1983-85, 1992, and 1996.
- New major CHD events (fatal and non-fatal) were tracked using national registers and general practice records.
Main Results:
- A significant decline in the prevalence of current angina symptoms was observed between 1978 and 1996 (-1.8% annually).
- No significant trend was found in the prevalence of a history of diagnosed CHD (0.1% annually).
- CHD mortality rates decreased substantially (-4.1% annually), alongside reductions in non-fatal myocardial infarction and overall major CHD events.
Conclusions:
- Middle-aged British men report fewer angina symptoms but maintain a similar prevalence of diagnosed coronary heart disease.
- Despite falling rates of new CHD events and symptom prevalence, the necessity for secondary prevention in men with established CHD remains high.
- These findings underscore the persistent burden of established CHD and the continued importance of secondary prevention strategies.
Objective:
To assess whether long term trends over time in acute coronary heart disease (CHD) event rates have influenced the burden of prevalent CHD in British men.
Design:
Longitudinal cohort study.
Participants:
7735 men, aged 40-59 at entry (1978-80), selected from 24 British towns.
Methods:
The prevalences of current angina symptoms and history of diagnosed CHD were ascertained by questionnaire in 1978-80, 1983-85, 1992, and 1996. New major CHD events (fatal and non-fatal) were ascertained throughout the study from National Health Service central registers and general practice record reviews. Age adjusted trends in CHD prevalence were compared with trends in major CHD event rates.
Results:
From 1978-1996 there was a clear decline in the prevalence of current angina symptoms: the age adjusted annual percentage change in odds was -1.8% (95% confidence interval (CI) -2.8% to -0.8%). However, there was no evidence of a trend in the prevalence of history of diagnosed CHD (annual change in odds 0.1%, 95% CI -1.0% to 1.2%). Over the same period, the CHD mortality rate fell substantially (annual change -4.1%, 95% CI -6.5% to -1.6%); rates of non-fatal myocardial infarction, all major CHD events, and first major CHD event fell by -1.7% (95% CI -3.9% to 0.5%), -2.5% (95% CI -4.1% to -0.8%), and -2.4% (95% CI% -4.3 to -0.4%), respectively.
Conclusions:
These results suggest that middle aged British men are less likely to experience symptoms of angina than in previous decades but are just as likely to have a history of diagnosed CHD. Despite falling rates of new major events and falling symptom prevalence, the need for secondary prevention among middle aged men with established CHD is as great as ever.
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