Ischemic heart disease

1. Key messages

  • In 2018, 1.3% of the population reported suffering from angina pectoris. This percentage increases with age, reaching 3.8% in people aged 65 years and over.
  • In people aged 65 years and over, the self-reported prevalence of angina pectoris was higher in men in the three regions.
  • Between 2008 and 2018, the percentage of people aged 65 years and over reporting to suffer from angina pectoris has decreased in the three regions, in both genders, and more in women than in men.
  • In 2016, the number of people having been diagnosed with an acute myocardial infarction (AMI) was estimated at 19,948 in Belgium (177 cases per 100,000 inhabitants). Among them, 66.5% were men. The incidence rate of AMI increases with age and is higher in men in all age groups.
  • In 2016, in both genders, the age-adjusted incidence rate of myocardial infarction was higher in Wallonia, followed by Flanders and Brussels.
  • Between 2008 and 2016 (2015 not included), the age-adjusted incidence of myocardial infarction has decreased in both genders.

2. Background

Ischemic heart disease (IHD) is the main cause of death worldwide except in lowest-income countries. IHD, also called coronary heart disease, refers to heart problems caused by a narrowing of the coronary arteries (atherosclerosis), resulting in a reduced blood flow and oxygen supply (ischemia) to the heart muscle. In atherosclerosis, the arteries are narrowed when plaques build up inside, containing fat, cholesterol from low-density lipoproteins (LDL), fibrous tissues and sometimes calcium.

Many people do not experience any symptoms in the early stages of IHD. However, if left untreated, atherosclerosis progresses and symptoms may occur, which can be very disabling. The discomfort experienced when the heart muscle is lacking of oxygen is called angina pectoris. When the blockage of the blood flow is complete, the heart cells may die or suffer from serious damages, and this is what is called a myocardial infarction or a heart attack.

The main risk factors for IHD include physical factors such as high blood pressure, high cholesterol risk factor, diabetes, and behavioral factors such as tobacco use, unhealthy diet, alcohol abuse, and lack of exercise, which means that a part of the risk may be preventable by adopting a healthy lifestyle.

Two indicators are presented in the following sections:

  • The prevalence of angina pectoris refers to people who have reported suffering from angina pectoris during the last 12 months, and is derived from the Belgian Health Interview Survey [1]. We shall first describe the global prevalence in people aged 15 years and more; then we will focus on people aged 65 and over.
  • Different indicators can be defined to describe the occurrence of acute myocardial infarction (AMI). The "attack rate" (or incidence by episode) represents all first or recurrent events, while the term "incidence" means a first-ever event. Based on the availability of the data, we defined the yearly incidence as the first event in a given year. This indicator is built using the hospital discharge data from the Federal Public Service Health, Foodchain safety and Environment [2] from which infarction cases that were hospitalized and discharged alive are derived. It has to be noted that data of 2015 are not available due to the change of classification system from ICD-9 to ICD-10. To these cases have been added the cases of people who died of a heart attack (in hospital or not), extracted from the Sciensano Standardized Procedures for Mortality Analysis (SPMA) [3].

3. Angina pectoris prevalence

Situation in 2018

Belgium

In 2018, 1.3% of the population reported suffering from angina pectoris, a symptom of coronary heart disease. This percentage increases with age, going up from 0% in people aged 15-24 to 3.8% in people aged 65 years and over, and to 4.7% in people aged 75 and over.

Angina pectoris was more commonly reported among men, except in the 25-34 and 55-64 age groups. The age-adjusted self-reported prevalence of angina pectoris was higher in men (1.8%) than in women (1%).

Among people aged 65 and over, the prevalence was 3.8%.

The gender difference was more pronounced in people aged 65 and over, in whom the prevalence of angina pectoris was 2.5 times as high in men.

Self-reported prevalence of angina pectoris by age and sex, Belgium, 2018
Source: Health Interview Survey, Sciensano [1]
Regional differences

In 2018, among people aged 65 and over, the age-adjusted prevalence of angina pectoris was higher in men in all regions, with the most pronounced difference in Brussels.

Self-reported prevalence of angina pectoris in people aged 65 and over, by sex and region, 2018
Source: Own calculations based on Health Interview Survey, Sciensano [1]

Trends

Belgium

In people aged 65 and over, between 2008 and 2018, the age-adjusted prevalence of angina pectoris has decreased in both genders, but to a lesser extent in men (-24%, and not statistically significant) compared to women (-61%).

Regional differences

Among men aged 65 and over, the regional patterns have fluctuated over time and do not allow clear conclusions about the evolution.

Among women aged 65 and over, the prevalence of angina pectoris has steadily decreased in Flanders between 2008 and 2018. In Brussels, it has decreased between 2008 and 2013 and remained stable between 2013 and 2018. In Wallonia the decrease was not significant.

  • Men
  • Women

Self-reported prevalence of angina pectoris in men aged 65 and over, Belgium, 2008-2018
Source: Own calculations based on the Health Interview Survey, Sciensano [1]

Self-reported prevalence of angina pectoris in women aged 65 and over, Belgium, 2008-2018
Source: Own calculations based on the Health Interview Survey, Sciensano [1]

Socio-economic disparities

The crude self-reported prevalence of angina pectoris is higher in people with a low level of education, but after adjustment for age, there are no socio-economic disparities between the different levels of education, even among people aged 65 and over.

4. Acute myocardial infarction incidence

Situation in 2016

Belgium

In 2016, the number of persons having been diagnosed with an acute myocardial infarction (AMI) was estimated at 19,948 (177 diagnoses per 100,000 inhabitants), among which 15,545 were discharged alive and 4,403 died.

Among people with AMI, 66.5% were men. The number of persons having suffered of AMI was higher in men except in the oldest age groups (85+ years). This number was highest in age group 65-69 among men, and in age group 85-89 among women.

The incidence rate of AMI increases with age and is higher in men in all age groups.

  • Number of cases
  • Incidence rates

Incidence of myocardial infarction, number of cases by age and sex, Belgium, 2016
Source: Own calculations based on FPS Health, Food Chain Safety and Environment [2] and SPMA [3]

Incidence of myocardial infarction, incidence rate by age and sex, Belgium, 2016
Source: Own calculations based on FPS Health, Food Chain Safety and Environment [2] and SPMA [3]

Regional differences

In 2016, the crude and age-adjusted incidence rate of AMI was the lowest in Brussels, which means that it is not due to the younger age structure of the population in the capital.

In Wallonia, the age-adjusted incidence rate of AMI was 291 per 100,000 among men and 113 per 100,000 among women, which was above the Belgian incidence rate (respectively 263 per 100,000 and 103 per 100,000).

  • Men
  • Women

Incidence of myocardial infarction in men by region, Belgium, 2016
Source: Own calculations based on FPS Health, Food Chain Safety and Environment [2] and SPMA [3]

Incidence of myocardial infarction in women by region, Belgium, 2016
Source: Own calculations based on FPS Health, Food Chain Safety and Environment [2] and SPMA [3]

Trends

Belgium

Between 2008 and 2016 (2015 not included), the age-adjusted incidence of myocardial infarction has decreased in both genders, going from 357 per 100,000 in 2008 to 263 per 100,000 in 2016 in men and from 149 per 100,000 in 2008 to 103 per 100,000 in 2016 in women. This decrease was less pronounced in men (-26%) than in women (-31%).

Incidence of myocardial infarction by sex, Belgium, 2008-2016*
Source: Own calculations based on FPS Health, Food Chain Safety and Environment [2] and SPMA [3]
* 2015 not included
Regional differences

Between 2008 and 2016 (2015 not included), in both genders, the crude incidence of myocardial infarction has decreased in the three regions. Among men, this decrease was higher in Brussels (-23%) compared to Flanders (-19%) and Wallonia (-18%). Among women, the change was more pronounced in Flanders (-28%) compared to Brussels (-25%) and Wallonia (-23%).

  • Men
  • Women

Crude incidence of myocardial infarction among men, Belgium, 2008-2016*
Source: Own calculations based on FPS Health, Food Chain Safety and Environment [2] and SPMA [3]
* 2015 not included

Crude incidence of myocardial infarction among women, Belgium, 2008-2016*
Source: Own calculations based on FPS Health, Food Chain Safety and Environment [2] and SPMA [3]
* 2015 not included

5. Read more

View the metadata for this indicator

Definitions

Angina pectoris or angor
Angina pectoris, or angor, is one of the symptoms of coronary heart disease. Angor is defined as a pain or discomfort in the chest or adjacent areas, precipitated by exercise, emotion or a heavy meal, caused by a reduced supply of oxygen to the heart (ischemia) due to a stenosis (narrowing) or blockage of the coronary arteries.
Acute myocardial infarction
Acute myocardial infarction (AMI), also called heart attack, is a necrosis (death) of the heart cells, resulting from an acute obstruction of a coronary artery. The symptoms include chest pain or discomfort, dyspnea (shortness of breath), and nausea. In some cases, AMI can be asymptomatic. The main risk factors are age, tobacco, high blood pressure, high blood cholesterol, alcohol abuse, obesity and diabetes.

References

  1. Health Interview Survey, Sciensano, 1997-2018. https://his.wiv-isp.be/
  2. Federal Public Service Health, Food Chain Safety, and Environment. https://www.health.belgium.be/en/node/22892
  3. Standardized Procedure for Mortality Analysis (SPMA), Sciensano. https://spma.wiv-isp.be/SitePages/Methods_mortality.aspx