CHD Prevalence in US Shows No Significant Change, According to BRFSS Analysis

Coronary heart disease prevalence in the US between 2011 and 2018 saw a statistically insignificant change, from 6.2% to 6.0%, respectively.

Change in the prevalence of coronary heart disease (CHD) in the US from 2011 to 2018 was found statistically not significant, although modest variations were observed by sociodemographic group and state.

Specifically, self-reported CHD prevalence in 2011 was 6.2% and in 2018, 6.0%, according to findings published today in JAMA Cardiology.

Study authors, led by Yi-Ting Hana Lee, MPH, Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention (CDC) note that the decline in CHD death rates began to slow in 2011. Lee and team were interested in the trends in prevalence going forward from that time and turned to data from the Behavioral Risk Factor Surveillance System (BRFSS), from 2011 to 2018.

The BRFSS telephone survey annually collects self-reported data from noninstitutionalized adults (aged ≥18 years) in the 50 states, DC, and US territories.

Participants were defined as having self-reported CHD if they responded affirmatively to 1 of 2 questions: “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?”

Lee et al examined CHD prevalence by age, sex, race and ethnicity, education, household income, and health insurance coverage. The final analytic data set numbered 3 572 977, after excluding participants with incomplete information or a history of CHD. The investigators age-standardized annual prevalence estimates to the 2000 US standard population and then examined trends by sociodemographic characteristic and state.

Range of change, marginal significance

The change in CHD prevalence from 2011 – 2018 (6.2% to 6.0%) was calculated as statistically insignificant (absolute change, -0.11%; 95% confidence interval [CI], -0.3 to 0.1, P = .22).

Looking at data by individual state, the decrease in CHD prevalence in Utah was statistically significant (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) just approached significance.

The analysis found small but statistically significant decreases in prevalence of CHD among adults aged ≥65 years (absolute change, −1.82%; 95% CI, −2.4 to −1.2; P < .001) and among college graduates (-0.35%; 95% CI, -0.6 to -0.1, P =.002) while a relatively small but significant increase (absolute change, 0.34%; 95% CI, 0.2 to 0.5; P < .001) was seen among younger adults, aged 18 to 44 years.

CHD prevalence across US states ranged from 4.0% in DC to 10.6% in West Virginia.

In 2018, prevalence of heart disease was higher among men than women (7.7% vs 4.6%).

In 2010, Lee and colleagues write, a BRFSS-based study of trends in CHD prevalence reported a decline from 6.7% in 2006 to 6.0% in 2010. And although changes in the BRFSS sampling frame preclude a direct comparison, the 2 data sets do suggest that the downward trend may be slowing.

They point to the worrisome increase in rates of CHD risk factors, including obesity, type 2 diabetes, sodium intake, and hypertension, as potentially influencing trends in CHD prevalence and mortality.

Limitations to the study identified by the authors include the self-reported nature of the data and the exclusion of congregate settings in data collection.

They conclude by urging “…rigorous broad-scale CHD preventive and management efforts.”

Reference: Hana Lee YT, Fang J, Scheib L, et al. Prevalence and trends of coronary heart disease in the United States, 2011 to 2018. [research letter] JAMA Cardiol. Published online January 19, 2022. doi:10.1001/jamacardio.2021.5613