National Change in Coronary Heart Disease Prevalence Not Significant in US

New research on recent trends in self-reported prevalence of coronary heart disease (CHD) found the national change in CHD prevalence was not considered significant, with variations observed by sociodemographic group and state.

Led by Cathleen Gillespie, MS, Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, the team evaluated trends based on Behavioral Risk Factor Surveillance System (BRFSS) data from 2011 - 2018.

“Statistically significant, albeit modest, declines and increases were observed for some sociodemographic groups and states,” investigators wrote.

The Study

Self-reported data in the BRFSS is collected from an annual telephone survey of the noninstitutionalized population (aged ≥18 years) of the 50 states, DC, and US territories.

The system defined self-reported CHD if participants responded positively to “Has a doctor, nurse, or other health professional ever told you that you had angina or coronary heart disease?” or “Has a doctor, nurse, or other health professional ever told you that you had a heart attack, also called a myocardial infarction?.”

Prevalence was examined by age, sex, race and ethnicity, education, household income, and health insurance coverage. Following exclusion, a population of 3,572,977 adults were included in the analytic data set. Then, annual prevalence estimates were age-standardized to the 2000 US standard population, with study examining trends by sociodemographic characteristic and state.

Data

From 2011 - 2018, data show the change in CHD prevalence (6.2% to 6.0%) was statistically insignificant (absolute change, -0.11%; 95% CI, -0.3 to 0.1, P = .22).

By region specificity, investigators observed a significant decrease in prevalence in Utah (absolute change, -1.09%; 95% CI, -1.71 to 0.46, P <.001), while declines in DC (-1.28%; 95% CI, -2.29 to –0.27, P = .01), California (-0.72%; 95% CI, -1.36 to -0.08, P = .03), and Nebraska (-0.70%; 95% CI, -1.25 to -0.16, P = .01) approached significance.

Adults ≥65 years and college graduates were seen to have small, but statistically significant decreases in CHD prevalence (absolute change, -1.82%; 95% CI, -2.4 to -1.2, P <.001 and -0.35%; 95% CI, -0.6 to -0.1, P =.002).

However, those aged 18 - 44 years had a small, but statistically significant increase (absolute change, 0.34%; 95% CI, 0.2 - 0.5, P <.001).

Additionally, in 2018, CHD prevalence was greater among men (7.7%), compared to women (4.6%) and no statistical difference was found by health insurance coverage. By state, CHD prevalence ranged from 4.0% in DC to 10.6% in West Virginia.

Takeaways

Investigators noted trends in other risk factors, such as obesity, type 2 diabetes, high sodium intake, and hypertension, may have important implications for CHD prevalence and mortality trajectories.

“Findings highlight the need for rigorous broad-scale CHD preventive and management efforts,” investigators wrote.

The study, “Prevalence and Trends of Coronary Heart Disease in the United States, 2011 to 2018,” was published in JAMA Cardiology.