Recent temporal changes in atherosclerotic cardiovascular diseases in Ontario: clinical and health systems impact

Background — It is unknown how the contemporary burden of atherosclerotic cardiovascular diseases (ASCVD) compares with historical trends.

Methods — As part of the Cardiovascular Health in Ambulatory Care Research Team “big data” initiative, we used information from multiple population-based databases to study 20-year temporal trends in hospitalizations and deaths from ASCVDs. We calculated hospitalization rates for six ASCVD events (acute myocardial infarction, unstable angina, stroke, transient ischemic attack, peripheral arterial disease, and congestive heart failure) and death rates due to ischemic heart disease, cerebrovascular disease and circulatory and non-circulatory causes, in adults aged 20 to 105 in Ontario, Canada from 1994 to 2014 (to 2012 for deaths).

Results — The overall age-standardized composite rate of hospitalization for the six conditions or circulatory deaths declined 49.2% from 1533.4 per 100,000 in 1994 to 778.3 per 100,000 in 2012 in males, and 49.9% from 1191.2 per 100,000 in 1994 to 596.2 per 100,000 in 2012 in females. The annual rates of decline were least evident among those aged 20-49 for both sexes. The overall self-reported prevalence of Ontarians living with heart disease and/or stroke declined non-significantly (p for trend=0.19) from 7.7% to 7.1% for males, and significantly (p for trend=0.01) from 7.3% to 5.8% for females from 2001 to 2012.

Conclusions — Striking declines in hospitalizations and deaths from ASCVD were observed in Ontario from 1994-2014. However, the limited progress observed in younger Canadians highlights the need for ongoing efforts aimed at preventing and treating ASCVDs and their associated risk factors.