University of Oxford: UK Study Reveals Evolving Trends and Ongoing Challenges in Heart Disease Over Two Decades

Researchers analysed electronic health records from the Clinical Practice Research Datalink (CPRD GOLD and Aurum), encompassing a representative cohort of 22 million individuals. This included 1,650,052 people newly diagnosed with at least one cardiovascular disease (CVD) between 2000 and 2019, with an average age of 70.5 years, of whom 48% were women.

The study was conducted by a consortium of experts from four European Universities – the University of Oxford’s Nuffield Department of Women’s & Reproductive Health, KU Leuven, the University of Glasgow, and the University of Leicester.

The study revealed four main findings, which were:

• Overall Decline in Heart Disease: The study found a 19% drop in the overall incidence (ie. the number of new diagnoses) of heart-related diseases from 2000 to 2019, including major reductions in heart attacks and strokes, with incidences down by about 30%.
• Rising Cases of Other Conditions: While heart attacks and strokes have decreased, the study reports an increase in diagnoses of other heart conditions such as irregular heartbeats, valve problems, and blood clots. As a result of these varying trends, the overall incidence of cardiovascular disease across the ten conditions investigated have remained relatively stable since the years 2007-2008.
• Age Differences: Most of the improvements in heart health have been seen in people over 60. Younger age groups, however, haven’t experienced the same positive trends.
• Economic Disparities: The study highlights a troubling gap in heart disease rates between the rich and poor. People in the most deprived areas are nearly twice as likely to suffer from certain heart conditions compared to those in wealthier areas.

Despite significant strides in preventing heart attacks and strokes, the overall burden of heart disease remains high due to the rising incidence of other heart conditions. This means that while many people are benefiting from better heart health, there are still large segments of the population at risk, particularly younger people and those in economically disadvantaged areas.

The study’s authors emphasise that future efforts to combat heart disease must include a broader range of conditions and focus on the specific needs of younger and socioeconomically deprived populations. Public health strategies need to adapt to these new realities to continue the fight against heart disease effectively.

Dr. Nathalie Conrad, Senior research fellow at Oxford’s Nuffield Department of Women’s & Reproductive Health, and lead author of the study, said: ‘To date, cardiovascular disease prevention is largely focused on ischaemic heart disease and stroke. Our findings suggest that existing efforts have been successful in preventing, yet that other cardiovascular diseases increased in parallel. For example, our study shows that venous thromboembolism and heart block are now similarly common to heart attacks or strokes, yet these conditions receive much less attention in terms of prevention efforts. We hope that these findings will help raise awareness to expand research and prevention efforts to include the broader spectrum of cardiovascular presentations and their consequences.’

WHY THE RESULTS OF THIS STUDY ARE SO IMPORTANT

Understanding that heart disease isn’t just about heart attacks and strokes, but also includes conditions like arrhythmias and valve issues, can help individuals be more vigilant about their heart health. Increased awareness of these various heart conditions can lead to earlier detection and better management, potentially reducing the overall burden of cardiovascular diseases.

John McMurray, Professor of medical cardiology at the University of Glasgow, and senior author of the study, said: ‘While it is good news that the incidence of coronary heart disease and stroke has decreased overall, the lack of decline in younger people, the rise in other serious conditions such as heart failure, and the persistent socioeconomic gradient in cardiovascular problems means much still has to be done to improve the most important cause of ill health in the UK.’

Although the overall risk of developing cardiovascular disease before the age of 60 years is comparatively low, the fact that there were no improvements in the rate of coronary heart disease in younger age groups is of concern. This finding suggests that more efforts are needed to better identify those at high risk of developing cardiovascular disease at a young age and develop new strategies on how we could best prevent these.

Finally, awareness that poorer communities are still at high risk can drive targeted public health campaigns and resources to where they are needed most. By focusing on these vulnerable populations, health authorities can develop and implement more effective prevention strategies, ultimately improving heart health outcomes for everyone.