Incidence and prevalence of coronary artery disease and cardiac arrest

The United States government publishes very detailed figures on the incidence and prevalence of heart disease. Incidence is the number of events or new diagnoses per year. Prevalence is the number of person with the disease at any given time. Thus, there were 13.2 million Americans with heart disease in 2003 (this is prevalence - number at any given time) and there were 1.2 million Americans with a diagnosis of new or recurrent coronary heart disease in 2003 (this is the annual incidence - number of new or recurrent cases in a year). The American Heart Association distills this information into an annual summary called Heart Disease and Stroke Statistics. (This document is available on the web at: www.americanheart.org/presenter.jhtml?identifier=1200026)

The 2008 update has 120 pages packed with graphs and tables. A few interesting figures:

34% of Americans have cardiovascular disease - defined as coronary heart disease (16 million), stroke (5.8 million), high blood pressure 73 million), heart failure (5.3 million).
The annual incidence of a new or recurrent coronary attack is 1.2 million (770,000 will have a new coronary attack and 430,000 will have a recurrent attack).
The lifetime risk of developing coronary heart disease assume you make it to age 40 is 49% for men and 32% for women.
Every minute in the United States someone dies from coronary heart disease.
The average number of years of life lost due to sudden cardiac arrest is 15 years 50% of men and 64% of women who die suddenly from coronary heart disease have no previous symptoms of the disease

Getting a handle on the number of sudden cardiac arrests is a bit trickier. If one looks only at death certificates the figure is 456,000 per year.(1) I think a more realistic figure is 155,000, the number of sudden deaths in which emergency medical services are called and attempt to resuscitate the individual. This lower figure gives a more realistic picture of the number of persons who are potentially "resuscitatable" from cardiac arrest since it does not include persons who are found cold and dead (even though their deaths may be coded as acute coronary heart disease).(2) To put this in perspective, the EMS system in King County in 2000 responded to 1428 calls for cardiac arrest but attempted resuscitation on 808. The other 620 were considered dead on arrival. In addition the vital statistics office in King County recorded 1029 out of hospital deaths from heart disease for which the EMS system was not called. There were also 1249 deaths in hospital without an out of hospital cardiac arrest. (The total deaths from heart disease was 3705 during the year) EMS personnel responded to 57% (1428/2457) of all out of hospital death events but only 39% (1428/3705) of all deaths.(3) One's head spins from all these figures. But let's not forget the 128 individuals who were resuscitated from cardiac arrest and discharged alive and did not become a vital statistic.

1. Zheng ZJ, Croft JB, Giles WH, Mensah GA. Sudden Cardiac Death in the United States, 1989 to 1998. Circulation 2001;104:2158-63.
2. Rea TD, Eisenberg MS, Sinibaldi G, White RD. Incidence of EMS-treated out-of-hospital cardiac arrest in the United States. Resuscitation 2004;63(1):17-24.
3. Rea TD, Eisenberg MS, Becker LJ, et al. Emergency medical services and mortality from heart disease: a community study. Ann Emerg Med 2003;41(4):494-9.