Epidemiology of Ischemic Heart Disease

IHD is the leading cause of disability and premature deaths worldwide. Men are affected more commonly than women. Onset starts fairly early with clinically manifest disease usually occurring after 50 years of age. Mortality rates rise with increasing age leading to a substantial number of deaths from 60 years of age onwards. Risk factors can be divided into two categories: traditional and emerging. Traditional or established risk factors can be further subdivided into modifiable (cigarette smoking, hypertension, diabetes, and hyperlipidemia) and non-modifiable (male sex, increasing age, and family history of premature IHD). Emerging risk factors include lifestyle and other clinical characteristics that have shown statistical association in observational studies. These putative risk factors include chronic inflammatory conditions such as psoriasis, nonalcoholic fatty liver disease, AIDS, as well as lifestyle choices such as meat consumption, prolonged sitting, and digital screen time. The mild cardioprotective effect of low alcohol consumption is outweighed by its overall harmful effects. Age-standardized rates have shown a decline in developed countries possibly due to improved awareness of heart health and decline in cigarette smoking. However, the total number and rates of IHD continue to rise placing tremendous burden on health systems. IHD could be considered a global health system emergency. Preventive cardiology and accessible primary care may be more cost effective than cardiac tertiary care. Key messages for health promotion and IHD prevention include avoiding cigarette smoking and alcohol; control of hypertension, diabetes, and dyslipidemia; and healthful nutrition with an active lifestyle.