MLHU - Health Status Resource

Cardiovascular disease

Cardiovascular disease
Key Findings: 

Cardiovascular diseases affect the circulatory system, which consists of the heart and the blood vessels that run throughout the body.1 Ischaemic heart disease (coronary heart disease) and cerebrovascular disease (stroke) are common types of cardiovascular disease.2 Cardiovascular diseases are chronic diseases of public health importance in which Ontario public health units have a mandate to reduce their burden through interventions that help prevent disease and promote health.3 In Middlesex-London from 2006 to 2018, rates of emergency department (ED) visits and hospitalizations for cardiovascular disease were higher among the rural population compared to the urban population, higher among males compared to females, and were highest among the older age groups (age 75 years and older). Cardiovascular diseases were the third leading cause of preventable death in Middlesex-London from 2013 to 2015; indicating an area where continued public health efforts are needed to help reduce preventable deaths in the population.

Cardiovascular disease Stroke
Ischaemic heart disease Hypertension
Cerebrovascular disease  

Cardiovascular disease

Rates of emergency department (ED) visits for cardiovascular disease were lower for Middlesex-London compared to Ontario from 2006 to 2017, but edged slightly higher than Ontario in 2018 (1,510.8 vs. 1,497.6 per 100,000) (Figure 7.1.1). However, the differences in rates were not statistically significant for the two most recent years, 2017 and 2018.

Rates of ED visits (Figure 7.1.2) and hospitalizations (not shown) for cardiovascular disease were higher among the rural population of Middlesex-London compared to the urban population from 2015 to 2017.

Hospitalization rates for cardiovascular disease were significantly lower for Middlesex-London compared to Ontario from 2006 to 2018 (Figure 7.1.3). Rates in Middlesex-London declined slightly over time.

Rates of ED visits (not shown) and hospitalizations (Figure 7.1.4) in Middlesex-London were significantly higher among males compared to females from 2006 to 2018.

When comparing across age groups in Middlesex-London in 2018, the rate of ED visits and hospitalizations for cardiovascular disease increased with age and were highest among those age 75 years and older (not shown).

Rates of death due to cardiovascular disease were slightly higher in Middlesex-London compared to Ontario from 2013 to 2015, but the differences were not statistically significant (Figure 7.1.5). Rates of death due to cardiovascular disease decreased over time for Middlesex-London, Ontario and the Peer Group from 2006 to 2015.

Middlesex-London death rates from cardiovascular disease in 2015 increased with age and was significantly higher among those age 75 years and older (1,950.1 per 100,000) (Figure 7.1.6).

Interpretation

Cardiovascular diseases affect the circulatory system, which consists of the heart and the blood vessels that run throughout the body.1 It is an umbrella term for diseases that affect the heart or blood vessels, including ischaemic heart disease, cerebrovascular disease, and hypertension.

Risk factors for cardiovascular disease include (but are not limited to): stress, poor diet, lack of physical activity, obesity, smoking, alcohol use, diabetes, hypertension, and high cholesterol.4 As a result, many cardiovascular diseases can be prevented or controlled through the adoption of healthy living behaviours—such as healthy eating, abstaining from smoking, limiting alcohol use, and living an active lifestyle.

Cardiovascular diseases are the leading cause of death in both adult men and women in Canada.2 However, among those under the age of 65, men are almost three times more likely to die from a cardiovascular disease compared to women.4

Ischaemic heart disease

The Leading Causes of Death section contains data showing that ischaemic heart disease was the leading cause of death in Middlesex-London from 2013 to 2015.

Among the Middlesex-London population age 12 and older, 4.9% reported having heart disease in 2015/16 (Figure 7.1.7). This percent was higher compared to Ontario (4.3%) and the Peer Group (4.6%), but the differences were not statistically significant.

Rates of ED visits for ischaemic heart disease in Middlesex-London were generally similar to Ontario from 2006 to 2018 (Figure 7.1.8). For Middlesex-London, Ontario and the Peer Group, rates of ED visits for ischaemic heart disease decreased significantly over time from 2006 to 2018.

Rates of ED visits (not shown) and hospitalizations (Figure 7.1.9) for ischaemic heart disease were higher among the rural population of Middlesex-London compared to the urban population from 2015 to 2017.

Hospitalization rates for ischaemic heart disease were significantly lower in Middlesex-London compared to Ontario from 2006 to 2018 (Figure 7.1.10). For Middlesex-London, Ontario and the Peer Group, rates of hospitalizations for ischaemic heart disease decreased over time from 2006 to 2018.

When comparing across age groups in Middlesex-London in 2018, the rate of ED visits and hospitalizations (Figure 7.1.11) for ischaemic heart disease increased with age and were highest among those age 75 years and older.

Rates of ED visits and hospitalizations in Middlesex-London were higher among males compared to females from 2006 to 2018 (not shown).

Death rates from ischaemic heart disease were slightly higher in Middlesex-London compared to Ontario in 2014 and 2015, but the differences were not statistically significant (Figure 7.1.12). For Middlesex-London, Ontario and the Peer Group, rates of death from ischaemic heart disease decreased over time from 2006 to 2015.

Rates of death from ischaemic heart disease were significantly higher among the rural population of Middlesex-London compared to the urban population from 2013 to 2015 (Figure 7.1.13). However, the differences in rates between the two populations narrowed during this time period.

Death rates from ischaemic heart disease were significantly higher among males compared to females in Middlesex-London from 2006 to 2015 (Figure 7.1.14). Rates among both groups generally decreased over this time period.

Interpretation

Ischaemic heart disease, also known as coronary heart disease, refers to heart problems caused by the buildup of plaque in the heart’s arteries.5 It is the most common type of cardiovascular disease in Canada2, and the second leading cause of death.5 It is estimated that 1 in 12 Canadians age 20 and over have ischaemic heart disease.5

The risk of ischaemic heart disease can be reduced through the early detection and management of health conditions such as high blood pressure (hypertension), diabetes, and high cholesterol.5

Cerebrovascular disease

The Leading Causes of Death section contains data showing that cerebrovascular diseases (including stroke) were the fourth leading cause of death in Middlesex-London from 2013 to 2015.

Rates of ED visits for cerebrovascular disease were slightly lower in Middlesex-London compared to Ontario from 2006 to 2018 (Figure 7.1.15), although the differences were not statistically significant in 2017 and 2018. For Middlesex-London, Ontario and the Peer Group, rates of ED visits increased slightly over time from 2006 to 2018.

Hospitalization rates for cerebrovascular disease were slightly lower in Middlesex-London compared to Ontario from 2006 to 2018 (Figure 7.1.16).

When comparing across age groups in Middlesex-London in 2018, the rate of ED visits and hospitalizations for cerebrovascular disease increased with age and were highest among those age 75 years and older (not shown).

Rates of ED visits (not shown) and hospitalizations (Figure 7.1.17) for cerebrovascular disease were higher among the rural population of Middlesex-London compared to the urban population from 2015 to 2017.

Rates of death from cerebrovascular disease were slightly higher in Middlesex-London compared to Ontario from 2013 to 2015, but the differences were not statistically significant (Figure 7.1.18). For Middlesex-London, Ontario and the Peer Group, rates of death from cerebrovascular disease declined over time from 2006 to 2015.

Across all age groups, the rate of death due to cerebrovascular disease was highest among those age 75 and older in Middlesex-London in 2015 (379.9 per 100,000) (Figure 7.1.19).

Interpretation

Cerebrovascular disease occurs when there is a problem with the circulation of blood in the blood vessels of the brain.2 Cerebrovascular disease includes stroke, carotid stenosis (narrowing of the carotid arteries, which supply blood to the brain), vertebral stenosis (narrowing of the vertebral arteries), intercranial stenosis (narrowing of the artery inside the brain), aneurysms (bulge in a blood vessel in the brain), and vascular malformations.6

Cerebrovascular diseases are the third most common causes of death in Canada.7 Most deaths due to cerebrovascular disease are due to stroke.8

Stroke

Among the Middlesex-London population age 12 years and older, 1.1% reported having the effects of stroke in 2015/16 (Figure 7.1.20). The percent was similar compared to Ontario (1.2%) and the Peer Group (1.0%).

Rates of ED visits for stroke were lower in Middlesex-London compared to Ontario from 2006 to 2018 (Figure 7.1.21); however, the differences were not statistically significant in 2017 and 2018. Rates in Middlesex-London, Ontario and the Peer Group increased over time from 2006 to 2018.

Rates of ED visits (not shown) and hospitalizations (Figure 7.1.22) for stroke were higher among the rural population of Middlesex-London compared to the urban population from 2015 to 2017.

Hospitalization rates for stroke were relatively stable in Middlesex-London from 2006 to 2018 (Figure 7.1.23). During this time period, rates were generally lower in Middlesex-London compared to Ontario, but the differences were not statistically significant in the most recent years.

When comparing across age groups in Middlesex-London in 2018, the rate of ED visits and hospitalizations for stroke increased with age and were highest among those age 75 years and older (not shown).

Rates of ED visits for stroke in Middlesex-London were higher among males compared to females from 2006 to 2018 (not shown). The differences in rates between females and males were often statistically significant during this time period.

Rates of death due to stroke decreased slightly over time in Middlesex-London from 2006 to 2015 (Figure 7.1.24). Rates of death from stroke in Middlesex-London were not significantly different compared to Ontario from 2006 to 2015.

Across all age groups, the rate of death due to stroke was highest among those age 75 and older in Middlesex-London in 2015 (305.7 per 100,000) (Figure 7.1.25).

Interpretation

A stroke is a type of cerebrovascular disease.9 It occurs when blood stops flowing to any part of the brain, which causes damage to the brain cells. The effects of a stroke depend on the part of the brain that was damaged and the amount of damage done.10 A stroke can happen at any age, but the risk increases sharply after the age of 55.11

High blood pressure (hypertension) is the biggest risk factor for a stroke.11 Almost 80% of premature stroke and heart disease can be prevented through healthy behaviours like eating healthy, being active, limiting alcohol use, and abstaining from smoking.10

Hypertension

Among the Middlesex-London population age 12 years and older, 16.8% reported having high blood pressure in 2015/16 (Figure 7.1.26). The percent was lower compared to Ontario (17.4%) and the Peer Group (18.1%), but the differences were not statistically significant.

Rates of ED visits for hypertension were significantly lower in Middlesex-London compared to Ontario from 2006 to 2018 (Figure 7.1.27). For Middlesex-London, Ontario and the Peer Group, rates increased gradually over time from 2006 to 2018.

In Middlesex-London, rates of ED visits and hospitalizations for hypertension were higher among the rural population compared to the urban population from 2015 to 2017, but the differences were generally not statistically significant (not shown).

When comparing across age groups in Middlesex-London in 2018, rates of ED visits and hospitalizations for hypertension increased with age and were highest among those age 75 years and older (not shown).

Rates of ED visits for hypertension in Middlesex-London were higher among females compared in males from 2006 to 2018 (Figure 7.1.28). The differences in rates between females and males were statistically significant in 2017 and 2018.

In terms of hospitalizations for hypertension, rates in Middlesex-London did not differ significantly between females and males from 2006 to 2017 (Figure 7.1.29).

Rates of death due to hypertension were similar in Middlesex-London compared to Ontario from 2006 to 2015 (Figure 7.1.30). Rates increased slightly over time from 2006 to 2015, but the differences were not statistically significant.

Interpretation

Hypertension, or high blood pressure, occurs when the blood pressure in the arteries is elevated and the heart has to work harder than normal to pump blood through the blood vessels.12 It is estimated that nearly one quarter of men (24%) and women (23%) in Canada have hypertension.13 After the age of 65, women are more likely than men to have hypertension.12

Hypertension is the number one risk factor for stroke and a major risk factor for heart disease.12 Risk factors for developing hypertension include: being overweight or obese, being physically inactive, or having a diet low in fruits and vegetables. Also, having diabetes increases the risk of developing hypertension by 68% in men and 125% in women.14

Ontario Public Health Standard: 

Ontario Public Health Standards: Requirements for Programs, Services, and Accountability
Population Health Assessment and Surveillance Protocol, 2018
Chronic Disease Prevention Guideline, 2018

References:

1. InformedHealth.org. How Does the Blood Circulatory System Work? [Internet]. Cologne, Germany: Institute for Quality and Efficiency in Health Care (IQWiG); 2010 [cited 2019 Sep 26]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK279250/

2. Public Health Agency of Canada. Six Types of Cardiovascular Disease [Internet]. Ottawa, ON: Government of Canada; 2010 [cited 2019 Sep 26]. Available from: https://www.canada.ca/en/public-health/services/chronic-diseases/cardiov...

3. Ministry of Health and Long-Term Care. Ontario Public Health Standards: Requirements for Programs, Services, and Accountability [Internet]. Toronto, ON: Queen's Printer for Ontario, 2018 [cited 2019 Jul 30]. Available from: http://www.health.gov.on.ca/en/pro/programs/publichealth/oph_standards/d...

4. Public Health Agency of Canada. Cardiovascular Disease [Internet]. Ottawa, ON: Government of Canada; 2016 [cited 2019 Sep 26]. Available from: https://cbpp-pcpe.phac-aspc.gc.ca/chronic-diseases/cardiovascular-diseases/

5. Public Health Agency of Canada. Heart Disease in Canada [Internet]. Ottawa, ON: Government of Canada; 2017 [cited 2019 Sep 23]. Available from: https://www.canada.ca/en/public-health/services/publications/diseases-co...

6. American Association of Neurological Surgeons. Cerebrovascular Disease [Internet]. Rolling Meadows, IL: American Association of Neurological Surgeons; 2019 [cited 2019 Sep 26]. Available from: https://www.aans.org/Patients/Neurosurgical-Conditions-and-Treatments/Ce...

7. Public Health Agency of Canada. Health Status of Canadians 2016: A Report of the Chief Public Health Officer [Internet]. Ottawa, ON: Government of Canada, 2016 [cited 2019 Sep 23]. Available from: https://www.canada.ca/en/public-health/corporate/publications/chief-publ...

8. Truelsen T, Begg S, Mathers C. The Global Burden of Cerebrovascular Disease [Internet]. Geneva, Switzerland: World Health Organization, 2006 [cited 2019 Sep 26]. Available from: https://www.who.int/healthinfo/statistics/bod_cerebrovasculardiseasestro...

9. Australian Bureau of Statistics. Stroke [Internet]. Canberra, NSW: Commonwealth of Australia; 2017 [cited 2019 Sep 26]. Available from: https://www.abs.gov.au/ausstats/abs

10. Heart and Stroke Foundation of Canada. Stroke [Internet]. Ottawa, ON: Heart and Stroke Foundation of Canada; 2018 [cited 2019 Sep 23]. Available from: https://www.heartandstroke.ca/stroke

11. Public Health Agency of Canada. Stroke in Canada Ottawa, ON: Government of Canada; 2016 [cited 2019 Sep 26]. Available from: https://www.canada.ca/en/public-health/services/publications/diseases-co...

12. Heart and Stroke Foundation of Canada. High Blood Pressure [Internet]. Ottawa, ON: Heart and Stroke Foundation of Canada; 2018 [cited 2019 Sep 23]. Available from: https://www.heartandstroke.ca/heart/risk-and-prevention/condition-risk-f...

13. Statistics Canada. Health Reports: Blood Pressure, Hypertension and Leading Risk Factors [Internet]. Ottawa, ON: Government of Canada; 2019 [cited 2019 Sep 23]. Available from: https://www150.statcan.gc.ca/n1/daily-quotidien/190220/dq190220a-eng.htm

14. Statistics Canada. Hypertension: Prevalence and Leading Risk Factors [Internet]. Ottawa, ON: Statistics Canada; 2019 [cited 2019 Sep 23]. Available from: https://www150.statcan.gc.ca/n1/pub/11-627-m/11-627-m2019007-eng.htm

Last modified on: November 18, 2019

Jargon Explained: 

Cerebrovascular disease
Disease that occurs when there is a problem with the circulation of blood in the blood vessels of the brain.2 It includes stroke, carotid stenosis (narrowing of the carotid arteries, which supply blood to the brain), vertebral stenosis (narrowing of the vertebral arteries), intercranial stenosis (narrowing of the artery inside the brain), aneurysms (bulge in a blood vessel in the brain), and vascular malformations.6

Ischaemic heart disease
Heart problems caused by the buildup of plaque in the heart’s arteries. It is also known as coronary heart disease.5

Stroke
A type of cerebrovascular disease that occurs when blood stops flowing to any part of the brain, which causes damage to the brain cells.

Cardiovascular disease
An umbrella term for diseases that affect the heart or blood vessels, including ischaemic heart disease, cerebrovascular disease, and hypertension.

Hypertension
Also known as high blood pressure. Occurs when the blood pressure in the arteries is elevated and the heart has to work harder than normal to pump blood through the blood vessels.12