Cardiovascular Disease

Definitions, Incidence, and Distribution

CVD comprises many conditions, including CHD, heart failure, rheumatic fever or rheumatic heart disease, stroke, and congenital heart disease. Of these, 7 in 10 deaths from CVD are due to CHD (53%) and stroke (17%) (Figure 1). CHD, the most common CVD condition, increases in prevalence directly with age in both men and women (Figure 2).

Myocardial infarction, angina pectoris (especially if requiring hospitalization), and sudden coronary death are the major clinical manifestations of CHD. CHD initially presents as sudden coronary death in approximately one third of the cases. Other forms of documented CHD include procedures done as a result of documented significant atherosclerosis, such as coronary artery bypass grafting (CABG) or percutaneous coronary interventions (PCI), including angioplasty and stenting. Persons with documented significant disease from a coronary angiogram, echocardiogram, nuclear myocardial perfusion, magnetic resonance imaging, or computed tomography angiographic or coronary calcium scan can also confirm the presence and extent of coronary artery disease; however, because the definitions used to define significant disease vary and/or such results do not typically result in hospitalization, these cases are not normally counted as incident or prevalent CHD, nor are they considered ‘hard’ (usually death or hospitalized diagnosed [Page 119]conditions) cardiovascular endpoints for the purposes of clinical trials. Nonfatal or fatal myocardial infarction and sudden coronary death are most typically included as ‘hard’ CHD endpoints.

Figure 1 Percentage Breakdown of Deaths From Cardiovascular Disease

Mortality rates from CVD and CHD vary widely across different countries. From the most recent data available, among men, CVD death rates per 100,000 range from 170 in Japan to 1,167 in the Russian Federation, with the United States at 307. Corresponding CHD death rates were 53, 639, and 187, respectively. Among women, these rates were lowest in France but highest in the Russian Federation, with intermediate rates in the United States. These rates were 69, 540, and 158 for CVD, respectively, and 18, 230, and 77 for CHD, respectively. Next to the Russian Federation, Romania, Bulgaria, and Hungary had the next highest rates both for CVD and CHD. Spain, Australia, Switzerland, and France (or Japan) were the other countries with the lowest rates.

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