Epidemiology

Coronary disease is the leading cause of morbidity and mortality in the US and worldwide.[4][5]​​ It is particularly common among older adults; in the US, the prevalence rises from 7.5% in men and 6.5% in women ages 40 to 59 years to 30.6% in men and 20.6% in women ages 80 years and older.[6]​​ In the US, the lifetime risk of developing coronary disease at age 40 years is one in two for men and one in three for women.[7] Globally, it was estimated that 197.2 million people had coronary disease in 2019, and it was more prevalent in men (113.7 million) than in women (83.6 million).[8] Despite a male predominance and roughly 10-year lag in incidence in women, coronary disease is the leading cause of mortality for women worldwide.[9][10]

In the US, Canada, and much of Europe, mortality from coronary disease has been declining since at least 1990.[11][12]​​​ This decline is likely caused by improvements in treatment as well as reductions in risk factors including smoking, hypertension, and hyperlipidemia.[13] There is concern that these improvements may be offset by increases in obesity, physical inactivity, and diabetes.[14] Globally, coronary disease mortality is increasing in lower- and middle-income countries such that it is now the leading cause of premature mortality in all but the least sociodevelopmentally advantaged nations.[5][15]

Prevalence of coronary disease varies widely both between and within countries.[4][11][12]​​​ Coronary disease and many of its risk factors (e.g., hypertension and hyperlipidemia) have both genetic and environmental influences. On the basis of a study of Swedish twins, the overall heritability of coronary disease is often cited as 40% to 60%.[16] Family history of coronary disease, particularly premature coronary disease, is a risk factor for ischemic events in middle-aged adults.[17] Socioeconomic inequalities are predispositions to coronary disease, and there is increasing attention to social determinants of health including social support, culture, language, access to care, neighborhood environment, and exposure to adversity.[12]​​[18][19][20]

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