What are the statistics and prevalence of atherosclerosis?

Atherosclerosis: Statistics and Prevalence

Atherosclerosis affects approximately 113 million people aged 40 and older worldwide, with a global prevalence of 1.52% that increases dramatically with age, reaching nearly 15% in those aged 80-84 years. 1

Global Prevalence and Demographics

• The global prevalence of atherosclerosis is approximately 1,470 per 100,000 persons, with 42.6% of cases occurring in countries with low-to-middle sociodemographic index 1
• Prevalence rose by 72% from 1990 to 2019, significantly outpacing the 45% growth rate in world population during the same period 1
• Atherosclerosis prevalence is higher in females than males in older age groups (18.03% vs. 10.56% in those aged 80-84 years) 1
• In the United States, the prevalence of atherosclerotic cardiovascular disease (ASCVD) remained relatively stable between 7.3% and 8.9% from 1999 to 2018, representing approximately 19.9 million individuals in 2015-2018 2, 3

Age-Related Patterns

• The risk of atherosclerotic cardiovascular disease increases substantially with age, with the highest incidence rates, prevalence, and treatment costs occurring in those 65 years and older 1
• At age 65, life expectancy is currently estimated to be >20 years for women and >17 years for men in most high-income countries, making the burden of atherosclerosis particularly significant in this population 1
• The prevalence of carotid stenosis (a manifestation of atherosclerosis) in the general population over 50 years increases with age, with studies showing 4.2% prevalence in men and 2.7% in women 1
• In elderly populations (>65 years), carotid plaques are found in 75% of men and 62% of women 1

Disease Burden and Mortality

• Atherosclerosis is the principal cause of cardiovascular disease, responsible for approximately 31% of all global deaths 4
• Coronary heart disease (CHD), the most prevalent form of atherosclerotic disease, is projected to increase by as much as 43% (approximately 5 million more cases) by 2030 in the United States due to demographic changes alone 1
• Associated direct costs for CHD might increase by as much as 198% (approximately $70 billion more) by 2030 1
• Ischemic cerebral disease, mainly linked to carotid stenosis (65% of cases), has a prevalence of 77.19 million globally, marking a 95% increase from 1990 to 2019 1
• Globally, in 2019, there were 172,000 aortic aneurysm-related deaths (an 82.1% increase from 1990) 1

Risk Factor Prevalence and Control

• Among patients with established atherosclerotic disease, there has been a significant increasing trend in the prevalence of diabetes, obesity, heavy alcohol consumption, and self-reported hypertension from 1999 to 2018 2
• Control rates for atherosclerosis risk factors have shown concerning trends:
  • Non-high-density lipoprotein cholesterol control (<100 mg/dL) increased from 7.1% in 1999-2002 to 15.7% in 2003-2006, before plateauing 2
  • Blood pressure control (<140/90 mm Hg) increased until 2011-2014, but declined to 70.1% in 2015-2018 2
  • Glycemic control (HbA1c <7%) began to decrease after 2006 2
• The percentage of patients achieving all three targets (lipid, blood pressure, and glycemic control) increased from 4.5% to 18.6% across 1999-2018, but this increasing trend decelerated after 2005-2006 2

Disparities in Prevalence and Treatment

• Black individuals have the highest risk for heart failure related to atherosclerosis 1
• In the ARIC (Atherosclerosis Risk in Communities) study, the incidence rate per 1,000 person-years was lowest among white women and highest among black men 1
• Heart failure in non-Hispanic black males and females has a prevalence of 4.5% and 3.8%, respectively, versus 2.7% and 1.8% in non-Hispanic white males and females 1
• Women have a significantly higher prevalence of hypertension than men (76.6% vs. 63.0%) and a significantly lower rate of control when treated pharmacologically (42.9% vs. 57.9%) 5
• Striking disparities in risk factor control and medication use persist between sexes and between different racial and ethnic populations 2

Medication Use and Treatment Patterns

• The percentage of ASCVD patients taking statins increased from 1999-2002 to 2011-2014, but then leveled off 3
• Approximately 60% of individuals with ASCVD and less than 40% of those with premature ASCVD were taking statins in 2015-2018 3
• The utilization of blood pressure-lowering drugs remained largely constant over time, whereas the use of glucose-lowering drugs increased 3
• Substantial undertreatment with statins was found in individuals with ASCVD, and the percentage achieving optimal lipid control remained low 3