eprintid: 10092606 rev_number: 24 eprint_status: archive userid: 608 dir: disk0/10/09/26/06 datestamp: 2020-03-04 17:37:18 lastmod: 2021-12-18 23:54:45 status_changed: 2020-03-04 17:37:18 type: article metadata_visibility: show creators_name: Sundaram, V creators_name: Bloom, C creators_name: Zakeri, R creators_name: Halcox, J creators_name: Cohen, A creators_name: Bowrin, K creators_name: Briere, J-B creators_name: Banerjee, A creators_name: Simon, DI creators_name: Cleland, JGF creators_name: Rajagopalan, S creators_name: Quint, JK title: Temporal trends in the incidence, treatment patterns, and outcomes of coronary artery disease and peripheral artery disease in the UK, 2006-2015 ispublished: pub divisions: UCL divisions: B02 divisions: DD4 keywords: CV mortality, Coronary artery disease, Incidence, Nationally representative health records, Peripheral artery disease, Statins note: This version is the author accepted manuscript. For information on re-use, please refer to the publisher’s terms and conditions. abstract: AIMS: Most reports estimating national incidence rates of coronary (CAD) and peripheral arterial disease (PAD) have focused on stable outpatients or acute or elective hospital admissions, but not on the overall burden of disease. In this study, we report the changing trends in the population-level incidence of CAD and PAD, respectively from 2006 to 2015, statin utilization for secondary prevention and survival outcomes using multiple nationally representative data sources from the UK (primary care encounters, hospital admissions, and procedure-level data). METHODS AND RESULTS: A nationally representative study of linked primary and secondary care electronic health records of 4.6 million individuals from the UK. We calculated crude and standardized annual incidence rates separately for CAD and PAD. Statin use for secondary prevention, trends in annual major vascular event rates, and mortality between 2006 and 2015, were estimated for CAD and PAD, respectively. We identified 160 376 and 70 753 patients with incident CAD and PAD, respectively. The age- and sex-standardized incidence of CAD was similar in 2006 (443 per 100 000 person-years) and 2015 [436 per 100 000 person-years; adjusted incidence rate ratio (IRR) 0.98, 95% confidence interval (CI) 0.96-1.00]. In contrast, there was a 15% decline in the standardized incidence of PAD (236 per 100 000 person-years in 2006 to 202 per 100 000 person-years in 2015; adjusted IRR 0.85, 95% CI 0.82-0.88). The proportion of incident CAD and PAD patients prescribed long-term statins, was only 66% and 55%, respectively and was less common amongst women, patients aged >70 years, with heart failure, chronic lung disease, or depression. Cardiovascular mortality declined by 43% for incident CAD (adjusted IRR 0.57, 95% CI 0.50-0.64) between 2006 and 2015 but did not decline for incident PAD (adjusted IRR 0.84, 95% CI 0.70-1.00). CONCLUSION AND RELEVANCE: In the UK, the standardized incidence of CAD appears stable but mortality rates are falling, whereas the standardized incidence of PAD is falling but mortality rates are not. date: 2020-05-01 date_type: published official_url: https://doi.org/10.1093/eurheartj/ehz880 oa_status: green full_text_type: other language: eng primo: open primo_central: open_green verified: verified_manual elements_id: 1733799 doi: 10.1093/eurheartj/ehz880 pii: 5688936 lyricists_name: Banerjee, Amitava lyricists_id: ABANE83 actors_name: Stacey, Thomas actors_id: TSSTA20 actors_role: owner full_text_status: public publication: European Heart Journal volume: 41 number: 17 pagerange: 1636-1649 event_location: England citation: Sundaram, V; Bloom, C; Zakeri, R; Halcox, J; Cohen, A; Bowrin, K; Briere, J-B; ... Quint, JK; + view all <#> Sundaram, V; Bloom, C; Zakeri, R; Halcox, J; Cohen, A; Bowrin, K; Briere, J-B; Banerjee, A; Simon, DI; Cleland, JGF; Rajagopalan, S; Quint, JK; - view fewer <#> (2020) Temporal trends in the incidence, treatment patterns, and outcomes of coronary artery disease and peripheral artery disease in the UK, 2006-2015. European Heart Journal , 41 (17) pp. 1636-1649. 10.1093/eurheartj/ehz880 <https://doi.org/10.1093/eurheartj%2Fehz880>. Green open access document_url: https://discovery.ucl.ac.uk/id/eprint/10092606/7/Banerjee_EURHEARTJ-D-19-01820_R3%20%281%29.pdf