Aims To report the prevalence, deaths, and disability-adjusted life years (DALYs) associated with ischemic heart disease (IHD) and its attributable risk factors in 204 countries and territories from 1990 to 2019, by age, sex, and socio-demographic index (SDI). Methods and results Ischemic heart disease was defined as acute myocardial infarction (MI) and chronic IHD (angina; asymptomatic IHD following MI). Cause of death ensemble modelling was used to produce fatality estimates. The prevalence of the non-fatal sequalae of IHD was estimated using DisMod MR 2.1. All estimates were presented as counts and age-standardized rates per 100 000 population. In 2019, IHD accounted for 197.2 million (177.7–219.5) prevalent cases, 9.1 million (8.4–9.7) deaths, and 182.0 million (170.2–193.5) DALYs worldwide. There were decreases in the global age-standardized prevalence rates of IHD [−4.6% (−5.7, −3.6)], deaths [−30.8% (−34.8, −27.2)], and DALYs [−28.6% (−33.3, −24.2)] from 1990 to 2019. In 2019, the global prevalence and death rates of IHD were higher among males across all age groups, while the death rate peaked in the oldest group for both sexes. A negative association was found between the age-standardized DALY rates and SDI. Globally, high systolic blood pressure (54.6%), high low-density lipoprotein cholesterol (46.6%), and smoking (23.9%) were the three largest contributors to the DALYs attributable to IHD. Conclusion Although the global age-standardized prevalence, death, and DALY rates all decreased. Prevention and control programmes should be implemented to reduce population exposure to risk factors, reduce the risk of IHD in high-risk populations, and provide appropriate care for communities.
Objective The aim of this systematic review and meta‐analysis was to provide a comprehensive estimate for spontaneous coronary artery dissection (SCAD) related mortality, and explore factors associated with an increased risk of death. Background SCAD is an infrequent but increasingly recognized cause of acute coronary syndrome. Despite a growing body of evidence, there have been few detailed examinations of SCAD associated mortality. Methods We searched MEDLINE, EMBASE, Cochrane, Web of Science and Google Scholar databases through May 7, 2020. We included studies reporting mortality data, confirmed SCAD with coronary angiography and included ≥10 participants. We excluded non‐English studies, conference abstracts, review articles and duplicate datasets. Random‐effects meta‐analysis and meta‐regression were used to evaluate estimates and predictors of mortality. Results From an initial 1,131 articles, 34 studies with 2,817 patients were eligible for inclusion. The weighted mean age was 50 years, and 84% of participants were female. The pooled estimate for SCAD mortality was 1% (Proportion 0.01; 95% CI, 0.00–0.02). The mean duration of follow‐up was 33 months. Meta‐regression showed male sex was associated with 3.5‐fold increased odds of mortality (OR, 3.50; 95% CI, 1.22–10.03). In addition, smoking (current or previous) was associated with a 15‐fold increased risk of mortality (OR 15.32; 95% CI, 2.88–81.41). Conclusions This meta‐analysis has shown that SCAD is associated with favorable survival outcomes with an estimated mortality of 1% over a mean follow‐up period of 33 months. We also found male sex and smoking were associated with an increased risk of mortality.
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