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Global epidemiology of acute coronary syndromes

Nature Reviews Cardiology volume 20, pages 778–788 (2023)Cite this article

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Abstract

This Review provides an epidemiological overview of global mortality from acute coronary syndromes (ACS). Across the regions of the world where data are available, mortality from ACS — including premature (age <70 years) mortality from ACS — was higher in men than in women. In both sexes, age-standardized mortality rates (ASMRs) for ACS in 2020 were highest in lower-income global regions. However, 20 years earlier, ASMRs for ACS were highest in higher-income global regions, including Europe, Northern America and Oceania. These higher-income regions have seen progressive reductions in mortality from ACS during the past 20 years, which is in contrast to the more stable levels of mortality from ACS in Asia and in Latin America and the Caribbean. In the seven African countries with data available, a small upwards trend in ASMRs for ACS was observed, reflecting an epidemiological transition that is already well advanced in these regions. Consistent with these changes during the past 20 years were >50% reductions in ASMRs for ACS in the high-income countries of the world compared with <15% reductions in lower-middle-income countries. Policymakers need more complete epidemiological data across and within global regions to identify those countries in which the burden of death from ACS is greatest and the need to implement preventive strategies is most pressing.

Key points

  • The availability of data on mortality from acute coronary syndromes (ACS) is heterogeneous between global regions and is particularly sparse across sub-Saharan Africa and large parts of Asia.

  • In all regions of the world with available data, age-standardized mortality rates (ASMRs) for ACS were higher in men than in women.

  • In 2020, ASMRs for ACS in both sexes were higher in lower-income regions (Africa, Asia, and Latin America and the Caribbean) than in higher-income regions (Europe, Northern America and Oceania).

  • In Europe, Northern America and Oceania, steep declines in ASMRs for ACS have occurred in both men and women in the past 20 years, but ASMRs for ACS have increased in several Latin American, Caribbean and Asian countries.

  • Consistent with these regional changes are marked reductions in ASMRs for ACS in high-income countries during the past 20 years, whereas ASMRs for ACS have increased in lower-middle-income countries in both men and women.

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Fig. 1: Global distribution of ASMRs for ACS.
Fig. 2: Regional changes in ASMRs for ACS between 2000 and 2020.
Fig. 3: Country-level changes in ASMRs for ACS between 2000 and 2020.

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Authors and Affiliations

  1. Queen Mary University, London, UK

    Adam Timmis

  2. European Heart Agency, European Society of Cardiology, Brussels, Belgium

    Adam Timmis, Denis Kazakiewicz, Nick Townsend, Radu Huculeci, Victor Aboyans & Panos Vardas

  3. School for Policy Studies, University of Bristol, Bristol, UK

    Nick Townsend

  4. Dupuytren University Hospital, Limoges, France

    Victor Aboyans

  5. Hygeia Hospitals Group, Hellenic Healthcare Group, Athens, Greece

    Panos Vardas

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All the authors researched data for the article. A.T., D.K., N.T., R.H. and P.V. contributed substantially to discussion of the content. A.T., N.T. and P.V. wrote the article. All the authors reviewed and/or edited the manuscript before submission.

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Institute for Health Metrics and Evaluation: https://www.healthdata.org/results/gbd_summaries/2019/ischaemic-heart-disease-level-3-cause

R Statistical Software: https://www.r-project.org

The World Bank. The World by Income and Region: https://datatopics.worldbank.org/world-development-indicators/the-world-by-income-and-region.html

UN grouping of countries by geographical regions: https://population.un.org/wpp/Download/Documentation/Documentation/

UN World Population Prospects: https://population.un.org/wpp/

WHO Global Health Observatory: https://www.who.int/data/gho/indicator-metadata-registry/imr-details/3411

WHO International Classification of Diseases: https://www.who.int/standards/classifications/classification-of-diseases

WHO Mortality Database: https://www.who.int/data/data-collection-tools/who-mortality-database

WHO World Standard Population (2000–2025): https://seer.cancer.gov/stdpopulations/world.who.html

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Timmis, A., Kazakiewicz, D., Townsend, N. et al. Global epidemiology of acute coronary syndromes. Nat Rev Cardiol 20, 778–788 (2023). https://doi.org/10.1038/s41569-023-00884-0

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