Ischemic heart disease

1. Key messages

2. Background

Ischemic heart disease (IHD) is the main cause of death worldwide except in lowest-income countries. IHD, also called coronary heart disease, refers to heart problems caused by a narrowing of the coronary arteries (atherosclerosis), resulting in a reduced blood flow and oxygen supply (ischemia) to the heart muscle. In atherosclerosis, the arteries are narrowed when plaques build up inside, containing fat, cholesterol from low-density lipoproteins (LDL), fibrous tissues and sometimes calcium.

Many people do not experience any symptoms in the early stages of IHD. However, if left untreated, atherosclerosis progresses and symptoms may occur, which can be very disabling. The discomfort experienced when the heart muscle is lacking of oxygen is called angina pectoris. When the blockage of the blood flow is complete, the heart cells may die or suffer from serious damages, and this is what is called a myocardial infarction or a heart attack.

The main risk factors for IHD include physical factors such as high blood pressure, high cholesterol risk factor, diabetes, and behavioral factors such as tobacco use, unhealthy diet, alcohol abuse, and lack of exercise, which means that a part of the risk may be preventable by adopting a healthy lifestyle.

Two indicators are presented in the following sections:

• The prevalence of angina pectoris refers to people who have reported suffering from angina pectoris during the last 12 months, and is derived from the Belgian Health Interview Survey [1]. We shall first describe the global prevalence in people aged 15 years and more; then we will focus on people aged 65 and over.
• Different indicators can be defined to describe the occurrence of acute myocardial infarction (AMI). The "attack rate" (or incidence by episode) represents all first or recurrent events, while the term "incidence" means a first-ever event. Based on the availability of the data, we defined the yearly incidence as the first event in a given year. This indicator is built using the hospital discharge data from the Federal Public Service Health, Foodchain safety and Environment [2] from which infarction cases that were hospitalized and discharged alive are derived. It has to be noted that data of 2015 are not available due to the change of classification system from ICD-9 to ICD-10. To these cases have been added the cases of people who died of a heart attack (in hospital or not), extracted from the Sciensano Standardized Procedures for Mortality Analysis (SPMA) [3].

For information concerning mortality, please consult the following pages: Overall mortality by cause and Premature mortality by cause.

3. Angina pectoris prevalence

Situation in 2018

Belgium

In 2018, 1.3% of the population reported suffering from angina pectoris, a symptom of coronary heart disease. This percentage increases with age, going up from 0% in people aged 15-24 to 3.8% in people aged 65 years and over, and to 4.7% in people aged 75 and over.

Angina pectoris was more commonly reported among men, except in the 25-34 and 55-64 age groups. The age-adjusted self-reported prevalence of angina pectoris was higher in men (1.8%) than in women (1%).

Among people aged 65 and over, the prevalence was 3.8%.

The gender difference was more pronounced in people aged 65 and over, in whom the prevalence of angina pectoris was 2.5 times as high in men.

Regional differences

In 2018, among people aged 65 and over, the age-adjusted prevalence of angina pectoris was higher in men in all regions, with the most pronounced difference in Brussels.

Trends

Belgium

In people aged 65 and over, between 2008 and 2018, the age-adjusted prevalence of angina pectoris has decreased in both genders, but to a lesser extent in men (-24%, and not statistically significant) compared to women (-61%).

Regional differences

Among men aged 65 and over, the regional patterns have fluctuated over time and do not allow clear conclusions about the evolution.

Among women aged 65 and over, the prevalence of angina pectoris has steadily decreased in Flanders between 2008 and 2018. In Brussels, it has decreased between 2008 and 2013 and remained stable between 2013 and 2018. In Wallonia the decrease was not significant.

Socio-economic disparities

The crude self-reported prevalence of angina pectoris is higher in people with a low level of education, but after adjustment for age, there are no socio-economic disparities between the different levels of education, even among people aged 65 and over.

4. Acute myocardial infarction incidence

Situation in 2017

Belgium

In 2017, the number of persons having been diagnosed with an acute myocardial infarction (AMI) was estimated at 20,253 (178 diagnoses per 100,000 inhabitants), among which 15,928 were discharged alive and 4,325 died.

Among people with AMI, 67.4% were men. The number of person having suffered of AMI was higher in men at any age excepted in oldest age groups (+85 years). The highest number of AMI was observed in age group 60-65 among men, and in age group 85-89 among women. The incidence rate of AMI increases with age and was higher in men in all age groups.

Regional differences

In Brussels, in 2017 the age-adjusted incidence of AMI was 227 per 100,000 among men and 81 per 100,000 among women, and hence lower compared to the other regions in both genders. In Wallonia, the age-standardized incidence rate of AMI was 284 per 100,000 among men and 108 per 100,000 among women, which was above the age-standardized Belgian incidence rate (respectively 269 per 100,000 and 102 per 100,000). In Flanders, the age--standardized incidence rate of AMI was 251 per 100,000 among men and 92 per 100,000 among women.

Trends

Belgium

Between 2008 and 2017 (2015 not included), the age-adjusted incidence of myocardial infarction has decreased in both genders, going from 301 per 100,000 in 2008 to 269 per 100,000 in 2017 in men and from 134 per 100,000 in 2008 to 102 per 100,000 in 2017 in women. This decrease was less pronounced among men (-10.6%) compared to women (-23.9%).

Regional differences

Between 2008 and 2017 (2015 not included), in both genders, the age-adjusted incidence of myocardial infarction has decreased in the three regions. Among men, this decrease was similar across all regions with a decrease of 11.3% in Flanders, a decrease of 10.6% in Brussels, and a decrease of 11.5% in Wallonia. Among women, the change was more pronounced in Brussels (-26.4%) and Flanders (-26.4%) compared to Wallonia (-21.7%).

5. Read more

View the metadata for this indicator

Definitions

Angina pectoris or angor

Angina pectoris, or angor, is one of the symptoms of coronary heart disease. Angor is defined as a pain or discomfort in the chest or adjacent areas, precipitated by exercise, emotion or a heavy meal, caused by a reduced supply of oxygen to the heart (ischemia) due to a stenosis (narrowing) or blockage of the coronary arteries.

Acute myocardial infarction

Acute myocardial infarction (AMI), also called heart attack, is a necrosis (death) of the heart cells, resulting from an acute obstruction of a coronary artery. The symptoms include chest pain or discomfort, dyspnea (shortness of breath), and nausea. In some cases, AMI can be asymptomatic. The main risk factors are age, tobacco, high blood pressure, high blood cholesterol, alcohol abuse, obesity and diabetes.

References

1. Health Interview Survey, Sciensano, 1997-2018. https://his.wiv-isp.be/
2. Federal Public Service Health, Food Chain Safety, and Environment. https://www.health.belgium.be/en/node/22892
3. Standardized Procedure for Mortality Analysis (SPMA), Sciensano. https://spma.wiv-isp.be/SitePages/Methods_mortality.aspx

Please cite this page as: Sciensano. Non-Communicable Diseases: Ischemic heart disease, Health Status Report, 29 Nov 2021, Brussels, Belgium, https://www.healthybelgium.be/en/health-status/non-communicable-diseases/ischemic-heart-disease