Angina module 1: epidemiology

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What is angina?

Figure 1. William Heberden who first described angina in 1768
Figure 1. William Heberden who first described angina in 1768

One of the earliest descriptions of angina pectoris was reported by William Heberden to the College of Physicians in London in 1768, and was published four years later (figure 1). He describes, “a disorder of the breast, marked with strong and peculiar symptoms…the sense of strangling with which it is attended, may make it not improperly be called angina pectoris. Those who are afflicted with it, are seized, while they are walking, and more particularly when they walk soon after eating, with a painful and most disagreeable sensation in the breast”.

Heberden’s keen observations now make up the well-recognised syndrome of chest pain or pressure precipitated by activities such as exercise or emotional stress, which increase myocardial oxygen demand. While angina can be caused by various cardiovascular conditions, including coronary spasm and aortic valve disease, in the majority of patients reduced myocardial perfusion is due to arterial narrowings resulting from underlying atherosclerotic coronary heart disease (CHD).1

Key facts

Table 1. Total deaths by cause, 2012, United Kingdom
Table 1. Total deaths by cause, 2007, United Kingdom
  • Cardiovascular disease (CVD) is the number one cause of death globally,2 and remains the single greatest killer in Europe, accounting for over 4.30 million deaths annually.3
  • In the UK in 2012, for the first time since 1961, CVD went from being the first to the second main cause of death. CVD caused 28% of all deaths – a total of 161,252 – while cancer caused 29% (see table 1)4
  • Just under half of these deaths (46%) are from coronary heart disease (CHD), by itself the most common cause of premature death in the UK, and roughly a quarter from stroke (26%).4
  • 50% of patients with CHD have stable angina pectoris as their first clinical presentation.5
  • A similar pattern is seen in the Irish Republic6 where there are approximately 10,000 CVD deaths each year, mainly myocardial infarctions (n=5,000) representing 36% of all deaths in a population of around 4.4 million.

Prevalence

Chronic stable angina pectoris affects around 2–4% of the population in Western countries,7 and it is associated with an estimated annual risk of death and non-fatal myocardial infarction (MI) of 1–2% and 3%, respectively.7 Applying country and age specific population estimates to prevalence data suggests that more than 1.3 million people in the UK are living with angina (approximately 775,000 men and 560,000 women).4

Figure 2. Angina prevalence in the UK
Figure 2. Angina prevalence in the UK

Angina’s prevalence is higher than that for either MI or stroke, reaching levels of around 5% of men and 4% of women in the UK (figure 2).8 Prevalence is higher in men than in women, and increases sharply with age – between the ages of 65 and 74 years the proportions are about 14% for men and 8% for women.9

Recent estimates are that angina affects 8,365,000 people in the United States – 4,070,000 men and 4,295,000 women aged 20 or older.10