REFERENCE CODE GDHCER053-14 | PUBLICAT ION DATE JULY 2014
ACUTE CORONARY SYNDROME (ACS) - EPIDEMIOLOGY FORECAST TO 2023
Acute Coronary Syndrome (ACS) - Epidemiology Forecast to 2023 2 © GlobalData. This report is a licensed product and is not to be copied, reproduced, shared or resold in any form.
ACUTE CORONARY SYNDROME (ACS) - EPIDEMIOLOGY FORECAST TO 2023
Executive Summary
Acute coronary syndrome (ACS) is a serious
cardiovascular disease associated with high
healthcare costs, frequent recurrences and
hospitalizations, and high risks of sudden death
and short-term mortality. The ACS incidence
increases with age and will be a significant public
health problem as the elderly population increases
around the world. ACS is classified into three
disease entities based on evidence of heart muscle
damage inferred from a person’s symptoms,
changes in the ST-tracing of the electrocardiogram
(ECG), and levels of cardiac biomarkers that
signify heart muscle death: ST-elevation
myocardial infarction (STEMI), non-ST-elevation
myocardial infarction (NSTEMI), and unstable
angina (UA). These three disease entities differ in
their clinical characteristics, treatment approaches,
and survival probabilities.
This report provides an overview of the ACS risk
factors and comorbidities, a discussion of the ACS
global and historical trends, and a 10-year
epidemiological patient forecast for ACS from 2013
to 2023 in the seven major markets (7MM) (US,
France, Germany, Italy, Spain, UK, and Japan).
The epidemiological patient forecast includes:
Hospitalized incident cases of ACS,
segmented by STEMI, NSTEMI, and UA
ACS cases that survived until hospital
discharge, segmented by STEMI, NSTEMI,
and UA
ACS cases that survived for one year post-
hospital discharge, segmented by STEMI,
NSTEMI, and UA
Diagnosed prevalent cases of myocardial
infarction (MI) segmented by STEMI and
NSTEMI from 2013 to 2023 in the six major
markets (6MM) (US, France, Germany, Italy,
Spain, and UK)
Belo mentioned figure presents the forecast for the
hospitalized incident ACS cases in the 7MM for
men and women ages ≥25 years for 2013 and
2023. In the 7MM, the hospitalized incident cases
of ACS will increase from 1.29 million cases in
2013 to 1.47 million cases in 2023 at the rate of
1.40% per year. The US constitutes around 40% of
the total hospitalized incident ACS cases in the
7MM and will be the market with the highest
number of cases during the forecast period. The
majority of the cases occurred in men (58.15%)
and in those ages ≥65 years (69.34%). For the
7MM, about 33% of the ACS cases were STEMI,
44% were NSTEMI, and 23% were UA. The
proportions varied depending on the market.
Acute Coronary Syndrome (ACS) - Epidemiology Forecast to 2023 3 © GlobalData. This report is a licensed product and is not to be copied, reproduced, shared or resold in any form.
ACUTE CORONARY SYNDROME (ACS) - EPIDEMIOLOGY FORECAST TO 2023
Executive Summary
7MM, Hospitalized Incident Cases of ACS, Ages ≥25 Years, Both Sexes, N, 2013 and 2023
62,229
66,385
98,735
104,935
149,050
261,007
543,795
637,406
1,286,136
68,260
72,529
100,782
121,916
172,047
299,583
630,646
713,201
1,465,763
0 500,000 1,000,000 1,500,000 2,000,000
Spain
France
UKJapan
Italy
GermanyUS
5EU
7MM
Hospitalized Incident Cases of ACS (N)
Mar
kets
20232013
Sources: GlobalData; ASL Brescia, 2011; Cequier, 2008; Degano et al., 2013; Ferreira-Gonzalez et al., 2008; Floyd et al., 2009; ISS, 2010; Löwel et al., 2006; Marrugat et al., 2000; Marrugat et al., 2002; Marrugat et al., 2004; McManus et al., 2011b; Peretti et al., 2012; Smolina et al., 2012a; Smolina et al., 2012b
Acute Coronary Syndrome (ACS) - Epidemiology Forecast to 2023 4 © GlobalData. This report is a licensed product and is not to be copied, reproduced, shared or resold in any form.
Table of Contents
ACUTE CORONARY SYNDROME (ACS) - EPIDEMIOLOGY FORECAST TO 2023
1 Table of Contents
1 Table of Contents ....................................................................................................................... 4
1.1 List of Tables ...................................................................................................................... 7
1.2 List of Figures ..................................................................................................................... 8
2 Introduction ............................................................................................................................... 10
2.1 Catalyst ............................................................................................................................. 10
2.2 Related Reports ................................................................................................................ 10
2.3 Upcoming Reports ............................................................................................................ 11
3 Epidemiology ............................................................................................................................ 12
3.1 Disease Background ......................................................................................................... 12
3.2 Risk Factors and Comorbidities ........................................................................................ 13
3.2.1 Controlling hypertension can decrease the CHD incidence by 20–25%......................... 14
3.2.2 Every 1% decrease in cholesterol levels is associated with a 2% decrease in the CHD risk ............................................................................................................................... 15
3.2.3 Women who have diabetes have a higher risk of developing CHD than men with diabetes........................................................................................................................ 16
3.2.4 Cigarette smoking increases the risk of CHD and also increases the risk of developing other risk factors for CHD ............................................................................................. 17
3.2.5 Obese and physically inactive persons are more likely to develop CHD through an increased risk of developing the traditional risk factors ................................................. 17
3.2.6 Non-modifiable risk factors, such as family history, age, and sex, contribute to CHD development ................................................................................................................. 18
3.2.7 Comorbidities ................................................................................................................ 18
3.3 Global Trends – MI ........................................................................................................... 19
3.3.1 MI Incidence and Mortality Trends ................................................................................. 19
3.3.2 STEMI and NSTEMI Trends .......................................................................................... 29
3.3.3 Trends in MI Mortality and Case-Fatality Rates ............................................................. 31
3.3.4 MI Prevalence ............................................................................................................... 33
Acute Coronary Syndrome (ACS) - Epidemiology Forecast to 2023 5 © GlobalData. This report is a licensed product and is not to be copied, reproduced, shared or resold in any form.
Table of Contents
ACUTE CORONARY SYNDROME (ACS) - EPIDEMIOLOGY FORECAST TO 2023
3.4 Global Trends – UA........................................................................................................... 34
3.5 Forecast Methodology ....................................................................................................... 36
3.5.1 Forecast Case Flow Map............................................................................................... 38
3.5.2 Sources Used................................................................................................................ 44
3.5.3 Sources Not Used ......................................................................................................... 53
3.5.4 Forecast Assumptions and Methods, Hospitalized MI Incident Cases ........................... 54
3.5.5 Forecast Assumptions and Methods, STEMI and NSTEMI Cases that Survived until Hospital Discharge ....................................................................................................... 59
3.5.6 Forecast Assumptions and Methods, STEMI and NSTEMI Cases that Survived for One Year after Discharge..................................................................................................... 61
3.5.7 Forecast Assumptions and Methods, Diagnosed Prevalent Cases of MI ....................... 62
3.5.8 Forecast Assumptions and Methods, Hospitalized Cases of UA.................................... 64
3.5.9 Forecast Assumptions and Methods, UA Cases that Survived until Hospital Discharge and for One Year Post-Discharge ................................................................................. 66
3.6 Epidemiological Forecast for ACS (2013–2023) – Hospitalized Incident Cases ................ 66
3.6.1 Hospitalized Incident Cases of ACS .............................................................................. 66
3.6.2 Age-Specific Hospitalized Incident Cases of ACS ......................................................... 68
3.6.3 Sex-Specific Hospitalized Incident Cases of ACS ......................................................... 70
3.6.4 Hospitalized Incident Cases of ACS by STEMI, NSTEMI, and UA ................................. 72
3.6.5 ACS Cases that Survived until Hospital Discharge and for One Year ............................ 74
3.6.6 Age-Specific ACS Cases that Survived until Hospital Discharge ................................... 77
3.6.7 Age-Standardized Incidence of ACS ............................................................................. 78
3.7 Epidemiological Forecast for MI (2013–2023) – Prevalent Cases ..................................... 79
3.7.1 Diagnosed Prevalent Cases of MI ................................................................................. 79
3.7.2 Diagnosed Prevalent Cases of MI Segmented by STEMI and NSTEMI......................... 81
3.7.3 Age-Specific Diagnosed Prevalent Cases of MI ............................................................ 82
3.7.4 Sex-Specific Diagnosed Prevalent Cases of MI ............................................................. 84
3.7.5 Age-Standardized Diagnosed Prevalence of MI ............................................................ 85
Acute Coronary Syndrome (ACS) - Epidemiology Forecast to 2023 6 © GlobalData. This report is a licensed product and is not to be copied, reproduced, shared or resold in any form.
Table of Contents
ACUTE CORONARY SYNDROME (ACS) - EPIDEMIOLOGY FORECAST TO 2023
3.8 Discussion ........................................................................................................................ 86
3.8.1 Epidemiological Forecast Insight ................................................................................... 86
3.8.2 Limitations of the Analysis ............................................................................................. 87
3.8.3 Strengths of the Analysis ............................................................................................... 88
4 Appendix................................................................................................................................... 91
4.1 Bibliography ...................................................................................................................... 91
4.2 About the Authors ........................................................................................................... 102
4.2.1 Epidemiologists ........................................................................................................... 102
4.2.2 Reviewers ................................................................................................................... 102
4.2.3 Global Director of Epidemiology and Health Policy ...................................................... 104
4.2.4 Global Head of Healthcare .......................................................................................... 105
4.3 About GlobalData ............................................................................................................ 106
4.4 About EpiCast ................................................................................................................. 106
4.5 Disclaimer ....................................................................................................................... 107
Acute Coronary Syndrome (ACS) - Epidemiology Forecast to 2023 7 © GlobalData. This report is a licensed product and is not to be copied, reproduced, shared or resold in any form.
Table of Contents
ACUTE CORONARY SYNDROME (ACS) - EPIDEMIOLOGY FORECAST TO 2023
1.1 List of Tables
Table 1: Risk Factors and Comorbidities for CHD and ACS ....................................................................... 14
Table 2: Germany, MI Incidence and Re-Infarction Rates (Cases per 100,000 Population), 1985–1987 and
2001–2003 .................................................................................................................................. 23
Table 3: Spain, MI Incidence Rate (Cases per 100,000 Population) and Incidence Trends, 2000 and 2013
................................................................................................................................................... 25
Table 4: England and Scotland, Temporal Trends in the MI Incidence (Cases per 100,000 Population),
2002–2010 .................................................................................................................................. 25
Table 5: 7MM, Summary of STEMI and NSTEMI In-Hospital and One-Year Case-Fatality Rates ............... 32
Table 6: Global, Crude Total Population Prevalence Percentages of Angina Pectoris and Mean Age of
Study Participants ....................................................................................................................... 35
Table 7: 7MM, Sources of MI and UA Incidence Data................................................................................ 40
Table 8: 7MM, Sources of Diagnosed Prevalence Data for MI ................................................................... 42
Table 9: 7MM, Data Sources of STEMI and NSTEMI Proportions Among Hospitalized Cases of MI .......... 43
Table 10: 7MM, Hospitalized Incident Cases of ACS, Ages ≥25 Years, Both Sexes, N (Col %), Selected
Years, 2013–2023 ....................................................................................................................... 67
Table 11: 7MM, Age-Specific Hospitalized Incident Cases of ACS, Both Sexes, N (Row %). 2013 .............. 69
Table 12: 7MM, Sex-Specific Hospitalized Incident Cases of ACS, Ages ≥25 Years, N (Row %), 2013 ........ 71
Table 13: 7MM, Hospitalized Incident Cases of ACS Segmented by STEMI, NSTEMI, and UA (N, Row %),
Ages ≥25 Years, Both Sexes, 2013 ............................................................................................. 73
Table 14: 7MM, ACS Cases that Survived until Hospital Discharge, Ages ≥25 Years, Both Sexes, N, 2013 . 76
Table 15: 7MM, ACS Cases that Survived for One Year Post-Discharge, Ages≥25 Years, Both Sexes, N,
2013............................................................................................................................................ 76
Table 16: 7MM, Age-Specific ACS Cases that Survived until Hospital Discharge and for One Year, Post-
Discharge Both Sexes, N, 2013 ................................................................................................... 78
Acute Coronary Syndrome (ACS) - Epidemiology Forecast to 2023 8 © GlobalData. This report is a licensed product and is not to be copied, reproduced, shared or resold in any form.
Table of Contents
ACUTE CORONARY SYNDROME (ACS) - EPIDEMIOLOGY FORECAST TO 2023
Table 17: 6MM, Diagnosed Prevalent Cases of MI, Ages ≥25 Years, Both Sexes, N (Col %), Select Years,
2013–2023 .................................................................................................................................. 80
Table 18: 6MM, Diagnosed Prevalent Cases of MI Segmented by STEMI and NSTEMI, Ages ≥25 Years,
Both Sexes, N (Row %), 2013 ..................................................................................................... 81
Table 19: 6MM, Age-Specific Diagnosed Prevalent Cases of MI, Both Sexes, N (Row %), 2013 ................. 83
Table 20: 6MM, Sex-Specific Diagnosed Prevalent Cases of MI, Ages ≥25 Years, N (Row %), 2013 ........... 84
Table 21: 7MM, Historical Data Validation ................................................................................................... 90
1.2 List of Figures
Figure 1: US, Temporal Trend in the Hospitalized MI Incidence from the Worcester Heart Attack Study, All
Ages, 1975–2005 ........................................................................................................................ 21
Figure 2: UK, Age-Adjusted MI Incidence and Hospitalized Incidence (Cases per 100,000 Population), Men,
2002–2010 .................................................................................................................................. 26
Figure 3: UK, Age-Adjusted MI Incidence and Hospitalized Incidence (Cases per 100,000 Population),
Women, 2002–2010 .................................................................................................................... 27
Figure 4: England and Scotland, Age-Adjusted Temporal Trends in MI Mortality, Deaths per 100,000
Population, Men and Women, 2002–2010 ................................................................................... 28
Figure 5: US, Germany, and UK, Crude Diagnosed MI Prevalence in Men and Women, 1990–2008 .......... 33
Figure 6: Global, Crude Total Population Prevalence Percentages of Angina Pectoris (%).......................... 36
Figure 7: MI Forecast Case Flow Map ........................................................................................................ 39
Figure 8: 7MM, Hospitalized Incident Cases of ACS, Ages ≥25 Years, Both Sexes, N, Select Years, 2013–
2023............................................................................................................................................ 68
Figure 9: 7MM, Age-Specific Hospitalized Incident Cases of ACS, Both Sexes, N, 2013 ............................. 70
Figure 10: 7MM, Sex-Specific Hospitalized Incident Cases of ACS, Ages ≥25 Years, N, 2013 ...................... 72
Figure 11: 7MM, Hospitalized Incident Cases of ACS Segmented by STEMI, NSTEMI, and UA, Ages ≥25
Years, Both Sexes, N, 2013 ........................................................................................................ 74
Acute Coronary Syndrome (ACS) - Epidemiology Forecast to 2023 9 © GlobalData. This report is a licensed product and is not to be copied, reproduced, shared or resold in any form.
Table of Contents
ACUTE CORONARY SYNDROME (ACS) - EPIDEMIOLOGY FORECAST TO 2023
Figure 12: 7MM, Survival of Hospitalized Incident Cases of ACS, Ages ≥25 Years, Both Sexes, %, 2013 ..... 75
Figure 13: 7MM, Age-Specific Survival of Hospitalized Incident Cases of ACS, Both Sexes, %, 2013 ........... 77
Figure 14: 7MM, Age-Standardized Incidence of ACS (Cases per 100,000 Population), Ages ≥25 Years, 2013
................................................................................................................................................... 79
Figure 15: 6MM, Diagnosed Prevalent Cases of MI, Ages ≥25 Years, Both Sexes, N, 2013–2023 ................ 80
Figure 16: 6MM, Diagnosed Prevalent Cases of MI Segmented by STEMI and NSTEMI, Ages ≥25 Years,
Both Sexes, N, 2013 ................................................................................................................... 82
Figure 17: 6MM, Age-Specific Diagnosed Prevalent Cases of MI, Both Sexes, N, 2013 ................................ 83
Figure 18: 6MM, Sex-Specific Diagnosed Prevalent Cases of MI, Ages ≥25 Years, N, 2013 ......................... 85
Figure 19: 6MM, Age-Standardized Diagnosed Prevalence of MI, Ages ≥25 Years, %, 2013 ........................ 86
Acute Coronary Syndrome (ACS) - Epidemiology Forecast to 2023 10 © GlobalData. This report is a licensed product and is not to be copied, reproduced, shared or resold in any form.
ACUTE CORONARY SYNDROME (ACS) - EPIDEMIOLOGY FORECAST TO 2023
Introduction
2 Introduction
2.1 Catalyst
Acute coronary syndrome (ACS) is a serious cardiovascular disease associated with high
healthcare costs, frequent recurrences and hospitalizations, and high risks of sudden death and
short-term mortality. The ACS incidence increases with age and will be a significant public health
problem as the elderly population increases around the world. ACS is classified into three disease
entities based on evidence of heart muscle damage inferred from a person’s symptoms, changes in
the ST-tracing of the electrocardiogram (ECG), and levels of cardiac biomarkers that signify heart
muscle death: ST-elevation myocardial infarction (STEMI), non-ST-elevation myocardial infarction
(NSTEMI), and unstable angina (UA). These three disease entities differ in their clinical
characteristics, treatment approaches, and survival probabilities.
The epidemiology of ACS in the 7MM has changed significantly during the past two decades and
varies between the western and Japanese markets. In order to capture the country-specific trends
and provide detailed patient population segmentation, GlobalData epidemiologists built separate
forecasts for (myocardial infarction) (MI) and UA in the 7MM and used a case-flow methodology to
determine the number of cases that survived until hospital discharge and for one year after hospital
discharge. Key results of the forecast are the following:
In the 7MM, the hospitalized incident cases of ACS will increase from 1.29 million cases in
2013 to 1.47 million cases in 2023 at the rate of 1.40% per year.
More ACS cases in the 7MM occurred in men (58.15%) than in women (41.85%).
For the 7MM, about 33% of the ACS cases were STEMI, 44% were NSTEMI, and 23% were
UA. The proportions varied depending on the market.
Acute Coronary Syndrome (ACS) - Epidemiology Forecast to 2023 11 © GlobalData. This report is a licensed product and is not to be copied, reproduced, shared or resold in any form.
ACUTE CORONARY SYNDROME (ACS) - EPIDEMIOLOGY FORECAST TO 2023
Introduction
2.3 Upcoming Reports
GlobalData (2014). PharmaPoint: Acute Coronary Syndrome Global Drug Forecast and Market
Analysis to 2023
Acute Coronary Syndrome (ACS) - Epidemiology Forecast to 2023 106 © GlobalData. This report is a licensed product and is not to be copied, reproduced, shared or resold in any form.
Appendix
ACUTE CORONARY SYNDROME (ACS) - EPIDEMIOLOGY FORECAST TO 2023
4.3 About GlobalData
GlobalData is a leading global provider of business intelligence in the healthcare industry.
GlobalData provides its clients with up-to-date information and analysis on the latest developments
in drug research, disease analysis, and clinical research and development. Our integrated business
intelligence solutions include a range of interactive online databases, analytical tools, reports, and
forecasts. Our analysis is supported by a 24/7 client support and analyst team.
GlobalData has offices in New York, San Francisco, Boston, London, India, Korea, Japan,
Singapore, and Australia.
4.4 About EpiCast
EpiCast is a series of premier epidemiology reports written and developed by Master’s-
and PhD-level epidemiologists.
EpiCast Reports are in-depth, high-quality, transparent, and market-driven, providing expert
analysis of epidemiological trends and forecasting of patient populations for major markets.
Specifically, the reports identify disease trends over a 10-year forecast period in six to seven major
markets (US, France, Germany, Italy, Spain, UK, and Japan). Additional countries, such as
Canada, Brazil, China, and India, are covered in these reports if their markets are highly relevant.
Acute Coronary Syndrome (ACS) - Epidemiology Forecast to 2023 107 © GlobalData. This report is a licensed product and is not to be copied, reproduced, shared or resold in any form.
Appendix
ACUTE CORONARY SYNDROME (ACS) - EPIDEMIOLOGY FORECAST TO 2023
4.5 Disclaimer
All Rights Reserved.
No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any
form by any means, electronic, mechanical, photocopying, recording or otherwise without the prior
permission of the publisher, GlobalData. The facts of this report are believed to be correct at the
time of publication, but cannot be guaranteed. Please note that the findings, conclusions, and
recommendations that GlobalData delivers will be based on information gathered in good faith from
both primary and secondary sources, whose accuracy we are not always in a position to
guarantee. As such, GlobalData can accept no liability whatever for actions taken based on any
information that may subsequently prove to be incorrect.