Population trends of recurrent coronary heart disease event rates remain high.

BACKGROUND Survivors of nonfatal coronary heart disease (CHD) can reduce their risk of further events by various preventive interventions. The impact of such measures as delivered over 11 years, on population rates of subsequent major CHD events, has not been extensively studied. This study determined population trends in the prevalence of clinically manifest CHD and the proportion of major CHD events that occur in this population. METHODS AND RESULTS A population longitudinal person-based event-linked file of CHD extracted from State Hospital Morbidity Data and Death Registry for 1980 to 2005 was used to identify, for each year from 1995 to 2005, survivors who had a hospitalization for CHD over the previous 15 years (population with established CHD), and to examine the occurrence of CHD death and hospitalization with a principal diagnosis of myocardial infarction in both populations with and without established CHD. The average annual age-standardized prevalence of CHD in the Perth metropolitan region (population 1.6 million) was 28 373 (8.8%) in men and 14 966 (4.0%) in women. Age-specific prevalence increased exponentially with age, from <1% in 35 to 39 age group to 42% in 80 to 84 age group in men and half that in women. The percentage of total CHD events (n=28 941) that occurred in the population with established CHD was approximately 43% in both men and women, 55% and 51%, respectively, for CHD death and 35% and 36% for nonfatal myocardial infarction. CONCLUSIONS More than 40% of major CHD events annually occur in persons with manifest disease, highlighting the imperative to implement systems of care that support effective secondary prevention.