Temporal trends in the incidence, treatment patterns, and outcomes of coronary artery disease and peripheral artery disease in the UK, 2006–2015

Author:

Sundaram Varun12,Bloom Chloe2ORCID,Zakeri Rosita23ORCID,Halcox Julian4,Cohen Alexander5ORCID,Bowrin Kevin6ORCID,Briere Jean-Baptiste7,Banerjee Amitava8ORCID,Simon Daniel I1ORCID,Cleland John G F29,Rajagopalan Sanjay1ORCID,Quint Jennifer K210ORCID

Affiliation:

1. Department of Cardiovascular Medicine, Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, 11100 Euclid Avenue, Cleveland, OH 44106, USA

2. Department of Population Health, National Heart and Lung Institute, Imperial College London, Emmanuel Kaye Building, Manresa Road, London SW3 6LR, UK

3. Department of Cardiovascular Medicine, Royal Brompton and Harefield Hospitals NHS Foundation Trust, London SW3 6NJ, UK

4. Department of Cardiovascular Medicine, Swansea University Medical School, Swansea, West Glamorgan, SA2 8PP UK

5. Department of Hematological Medicine, Guys and St Thomas NHS Foundation Trust, King's College London, Westminster Bridge Road, Denmark Hill, London SE5 9RS, UK

6. Bayer plc, Green Park, Reading RG2 6AD, UK

7. Bayer AG, Müllerstraße 7, 13353 Berlin, Germany

8. Institute of Health Informatics, University College London, 222 Euston Road, Regent's Park, London NW1 2DA, UK

9. Robertson Centre for Biostatistics and Clinical Trials, University of Glasgow, University Ave, Glasgow G12 8QQ, UK

10. Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel St, Bloomsbury, London WC1E 7HT, UK

Abstract

Abstract Aims Most reports estimating national incidence rates of coronary (CAD) and peripheral arterial disease (PAD) have focused on stable outpatients or acute or elective hospital admissions, but not on the overall burden of disease. In this study, we report the changing trends in the population-level incidence of CAD and PAD, respectively from 2006 to 2015, statin utilization for secondary prevention and survival outcomes using multiple nationally representative data sources from the UK (primary care encounters, hospital admissions, and procedure-level data). Methods and results A nationally representative study of linked primary and secondary care electronic health records of 4.6 million individuals from the UK. We calculated crude and standardized annual incidence rates separately for CAD and PAD. Statin use for secondary prevention, trends in annual major vascular event rates, and mortality between 2006 and 2015, were estimated for CAD and PAD, respectively. We identified 160 376 and 70 753 patients with incident CAD and PAD, respectively. The age- and sex-standardized incidence of CAD was similar in 2006 (443 per 100 000 person-years) and 2015 [436 per 100 000 person-years; adjusted incidence rate ratio (IRR) 0.98, 95% confidence interval (CI) 0.96–1.00]. In contrast, there was a 15% decline in the standardized incidence of PAD (236 per 100 000 person-years in 2006 to 202 per 100 000 person-years in 2015; adjusted IRR 0.85, 95% CI 0.82–0.88). The proportion of incident CAD and PAD patients prescribed long-term statins, was only 66% and 55%, respectively and was less common amongst women, patients aged >70 years, with heart failure, chronic lung disease, or depression. Cardiovascular mortality declined by 43% for incident CAD (adjusted IRR 0.57, 95% CI 0.50–0.64) between 2006 and 2015 but did not decline for incident PAD (adjusted IRR 0.84, 95% CI 0.70–1.00). Conclusion and relevance In the UK, the standardized incidence of CAD appears stable but mortality rates are falling, whereas the standardized incidence of PAD is falling but mortality rates are not.

Publisher

Oxford University Press (OUP)

Subject

Cardiology and Cardiovascular Medicine

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