Report From The Canadian Chronic Disease Surveillance System - Heart Disease in Canada, 2018 - Canada - Ca

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Report from the Canadian Chronic Disease Surveillance System:

Heart Disease in Canada, 2018
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Organization: Public Health Agency of Canada
Type: Report
Published: May 2018
Cat.: HP35-85/1-2018E-PDF
ISBN: 978-0-660-24021-3
Pub.: 170307
To promote and protect the health of Canadians through leadership, partnership, innovation and action in public health.
-Public Health Agency of Canada
Également disponible en français sous le titre : Rapport du système canadien de surveillance des maladies chroniques : Les
maladies du cœur au Canada, 2018
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Publication date: May 2018
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Cat.: HP35-85/1-2018E-PDF
ISBN: 978-0-660-24021-3
Pub.: 170307
Table of Contents
Executive summary
1. Introduction
1.1 Global burden of heart disease
1.2 Defining heart disease
1.3 Stages in the development of heart disease
1.4 Purpose of this report
2. Key findings
2.1 Improved cardiovascular health
2.2 Heart disease in men and women
2.3 Pan-Canadian perspective
3. Ischemic heart disease and heart failure relationship
3.1 Heart disease risk factors and treatments
3.2 Ischemic heart disease and heart failure comorbidity
Closing remarks
Appendix A: Canadian Chronic Disease Surveillance System
Appendix B: Heart disease case definitions
Appendix C: Methods
Appendix D: Limitations
Glossary
Acknowledgements
Bibliography
Executive summary
Heart diseases
In Canada, heart disease is the second leading cause of death, after cancer, and accounted for almost 20% of all deaths in
2012. Also known as ischemic heart disease or coronary heart disease, heart disease refers to the buildup of plaque in the
heart's arteries that could lead to a heart attack, a stroke or heart failure. Heart disease is the most common type of heart
conditions in Canada and other industrialized countries, accounting for almost half of all heart-disease-related deaths.
Purpose of this report

This report is the first publication to include administrative health data from the Canadian Chronic Disease Surveillance
System to support the national surveillance of ischemic heart disease and acute myocardial infarction (a subset of ischemic
heart disease also known as heart attack) among Canadian adults aged 20 years and older as well as heart failure among
Canadian adults aged 40 years and older. It features the most recent data available from the surveillance system (fiscal
year 2012–2013), as well as trend data spanning over a decade.
Key findings
In 2012–2013, about 2.4 million (or 1 in 12) Canadian adults aged 20 years and older were living with ischemic heart disease,
including 578,000 with a history of an acute myocardial infarction. Another 669,600 (3.6%) Canadians adults aged 40 years
and older were living with heart failure.
Heart disease outcomes are improving over time. From 2000–2001 to 2012–2013, age-standardized ischemic heart
disease and heart failure incidence and all-cause mortality rates declined, while the prevalence of both conditions
remained relatively stable. Respectively, incidence rates declined by 45% and 35% and all-cause mortality rates fell by
24% and 26%. A similar pattern was observed for acute myocardial infarction, although the occurrence increased by
about 67% over the study period.
Rates of death from any cause are higher among those with a heart disease than those without. Canadian adults
with ischemic heart disease (IHD) were three times more likely to die of any cause compared to those without the
disease in a given year. The outcome was least favorable for younger women and men aged 20 to 39 years old with
ischemic heart disease who were about 18 and 11 times more likely to die of any cause, respectively, than individuals of
the same age without IHD. Overall, individuals with a history of an acute myocardial infarction and those with heart
failure were four and six times more likely to die of any cause than those with neither condition in a given year.
Heart disease differs by sex. Heart disease appears about 10 years later in women than in men. In addition, age-
standardized prevalence and incidence rates of diagnosed ischemic heart disease and heart failure as well as the
occurrence of acute myocardial infarction were higher among men than women over the 13-year period. Similarly, age-
standardized all-cause mortality rates were higher in men than women, except for acute myocardial infarction where
women aged 45 to 74 years old were about 30% more likely to die of any cause than men of the same age in a given
year.
Although remarkable advancements in the prevention and management of heart disease have been made in the last few
decades, sustained efforts are needed to further prevent the development of heart disease risk factors, ensure early
detection and treatment, and close the gap in disease occurrence between women and men. Finally, the absolute number
of people living with a heart condition is increasing, thus the need for management and treatment resources for heart
disease will continue to be high.
1. Introduction
1.1 Global burden of heart disease
Heart disease is the leading cause of death globally. In 2015, an estimated 8.9 million people died from heart disease, which
represent 45% of all non-communicable disease deaths worldwide. 1 In addition, heart disease is the leading cause of
disability-adjusted life years (DALYs) lost due to ill-health, disability or early death worldwide. 2
Text Description
In Canada, although major improvements in treatment, disease management and public health interventions have been
made over the last few decades, heart disease is the second leading cause of death, 3 after cancer and a leading cause of
hospitalization. 4 Moreover, in Canada, heart disease is the number one cause of years of life lost 1 due to premature
mortality and second leading cause of DALYs lost in 2015. 2
1.2 Defining heart disease

Also known as coronary heart disease or ischemic heart disease (IHD), heart disease is a condition in which the heart
muscle is damaged or does not function properly. Plaque (composed of fat, cholesterol, calcium and other substances)
builds up on the inner walls of coronary arteries and, over time, it can harden or rupture. When plaque hardens, coronary
arteries get narrower and it reduces the flow of blood to the heart muscle which may cause chest pain or discomfort, called
angina. When plaque ruptures, a blood clot can form in a coronary artery and block blood flow to the heart, causing an
acute myocardial infarction (AMI), also known as heart attack. Similarly, a stroke may occur when blood flow to the brain
is interrupted or reduced. It happens when a brain blood vessel ruptures or when it is blocked.
Heart disease can also lead to heart failure and other types of heart disease, such as cardiac arrhythmias (abnormal heart
rhythm). 5 Heart failure occurs when the pumping action of the heart cannot provide enough blood to the rest of the body.
It results in an accumulation of fluid in the body, particularly in the lungs or legs. 6 The most common cause of heart failure
is damage to the heart muscle as a result of acute myocardial infarction.
1.3 Stages in the development of heart disease

Heart disease develops over decades. A number of events occur before it progresses to end-stage heart failure.
Behavioural risk factors such as unhealthy diet, physical inactivity, smoking, alcohol use and a number of medical risk
conditions (e.g. hypertension, diabetes, obesity and high cholesterol) increase a person's risk of developing heart disease
later in life. Without early detection, lifestyle modification and/or treatment, these risk factors may contribute to heart
failure or death as depicted in Figure A below.
Figure A. Events leading to heart disease progression
Figure adapted from Jessup M. et al 7 and Dzau VJ et al. 8
† Structural heart disease refers to a defect or abnormality in the heart's valves, heart muscle or blood vessels that can be present at
birth (congenital) or acquired later in life.
Figure A. Events leading to heart disease progression - Text Description

People at risk for heart disease and heart failure but without structural heart disease or symptoms of heart failure.
These include people with hypertension, diabetes, obesity, those who smoke and have high cholesterol. Then heart
disease may evolve into structural heart disease without any heart failure symptoms. These would include people with
ischemic heart disease, acute myocardial infarction or arrhythmia. Finally, it may evolve into heart disease with
symptoms of heart failure. These people would have known structural heart disease, shortness of breath and fatigue
as well as reduced exercise tolerance and ultimately, end-stage heart disease.
1.4 Purpose of this report

This is the first report from the Public Health Agency of Canada (PHAC) to include administrative health data from the
Canadian Chronic Disease Surveillance System (CCDSS) for the national surveillance of heart disease in Canada. It aims to
provide a national picture of the status of heart disease in Canada, in addition to highlighting trends spanning over a
decade (2000–2001 to 2012–2013). Using data from the CCDSS, estimates for IHD, as well as AMI [a subset of IHD] and heart
failure are described in this report. The CCDSS is a collaborative network of provincial and territorial chronic disease
surveillance systems, led by PHAC. Technical and methodological notes about the CCDSS as well as definitions used to
identify heart disease cases can be found in Appendices A-D. The data from the CCDSS on IHD, AMI and heart failure, as
well as many other chronic conditions can be accessed online through PHAC's Public Health Infobase (https://health-
infobase.canada.ca/).
2. Key findings
2.1 Improved cardiovascular health
Based on Canadian Chronic Disease Surveillance System (CCDSS) data from 2000–2001 to 2012–2013, a few common trends
were observed for ischemic heart disease (IHD), acute myocardial infarction (AMI) [a subset of IHD] and heart failure.
These trends are consistent with those reported in the Public Health Agency of Canada's Tracking Heart Disease and Stroke
in Canada report from 2009, which indicated that death rates for heart disease have decreased dramatically from 1969 to
2004. 6
2.1.1 Prevalence i
The age-standardized prevalence of diagnosed IHD, among individuals aged 20 years and older, increased from 7.1%
to 8.1% between 2000–2001 and 2004–2005 and then stabilizes (Figure 1A). The average annual percent change (AAPC)
in prevalence is less than one percent from 2000–2001 to 2012–2013. In contrast, the percentage of people with a
history of AMI ii increased from 1.2% in 2000–2001 to 2.0% in 2012–2013, representing an AAPC of 3.7% (Figure 1A).
The number of people living with IHD continues to increase over time, from about 1.5 million in 2000–2001 to 2.4
million in 2012–2013, including about 578,000 with a history of AMI in 2012–2013 (Figure 1A).
The age-standardized prevalence of heart failure, among individuals aged 40 years and older, remains stable at about
3.5% (Figure 1B). Similar to IHD, the AAPC in heart failure prevalence is less than one percent from 2000–2001 to 2012–
2013. Over the 13-year period, the number of people living with diagnosed heart failure increased from about 467,700
to 669,600.
Text Description
The number of Canadian adults aged 20 years and older with a history of heart attack (a subset of heart disease)
increased from approximately 251,000 to 578,000 between 2000–2001 and 2012–2013.
The proportion of Canadians with a history of heart attack increased by 67% over the same time period. This increase
likely reflects that more and more Canadians are surviving heart attacks.
Figure 1A. Prevalence (% † and number) of diagnosed ischemic heart disease (IHD) and occurrence (% † and number) of
acute myocardial infarction (AMI) among Canadians aged 20 years and older, Canada *, 2000–2001 to 2012–2013
Notes: The 95% confidence interval shows an estimated range of values which is likely to include the true value 19 times out of 20.
Source: Public Health Agency of Canada, using Canadian Chronic Disease Surveillance System data files contributed by provinces and
territories, May 2016.
† Age-standardized to the 2011 Canadian population.
* Data from Yukon were not available.
Figure 1A. Text description follows.
Figure 1A. Prevalence (% † and number) of diagnosed ischemic heart disease (IHD) and occurrence (%
† and number) of acute myocardial infarction (AMI) among Canadians aged 20 years and older,
Canada *, 2000–2001 to 2012–2013.
95% 95% Number of
Fiscal IHD Confidence AMI Occurence Confidence people with Number of people who had
Year prevalence Interval (IHD subset) Interval IHD an AMI (IHD subset)
2000- 7.1% 7.1-7.1 1.2% 1.2-1.2 1,526,340 251,560
2001
2001- 7.5% 7.5-7.5 1.3% 1.3-1.3 1,644,800 288,760
2002
2002- 7.7% 7.7-7.7 1.4% 1.4-1.4 1,747,830 323,850
2003
2003- 7.9% 7.9-7.9 1.5% 1.5-1.5 1,839,400 357,550
2004
2004- 8.1% 8.1-8.1 1.6% 1.6-1.6 1,920,150 387,260
2005
2005- 8.2% 8.2-8.2 1.7% 1.7-1.7 1,996,040 414,480
2006
2006- 8.2% 8.2-8.3 1.8% 1.7-1.8 2,065,270 439,580
2007
2007- 8.3% 8.3-8.3 1.8% 1.8-1.8 2,125,500 464,580
2008
2008- 8.3% 8.3-8.3 1.9% 1.9-1.9 2,182,720 488,560
2009
2009- 8.3% 8.3-8.3 1.9% 1.9-1.9 2,234,980 510,430

2010
2010- 8.2% 8.2-8.3 1.9% 1.9-1.9 2,288,290 533,460
2011
2011- 8.2% 8.2-8.2 1.9% 1.9-1.9 2,336,430 554,990
2012
2012- 8.1% 8.1-8.1 2.0% 2.0-2.0 2,381,500 578,040
2013
Figure 1B. Age-standardized † prevalence of diagnosed heart failure and number of people with heart failure, among
Canadians aged 40 years and older, Canada *, 2000–2001 to 2012–2013
Figure 1B. Text description follows.
Figure 1B. Age-standardized † prevalence of diagnosed heart failure and number of people with heart
failure, among Canadians aged 40 years and older, Canada *, 2000–2001 to 2012–2013
Fiscal Year Prevalence 95% Confidence Interval Number of people
2000-2001 3.4% 3.4-3.4 467,710
2001-2002 3.5% 3.5-3.5 498,130
2002-2003 3.5% 3.5-3.6 521,250
2003-2004 3.6% 3.6-3.6 542,230
2004-2005 3.6% 3.6-3.6 558,280
2005-2006 3.6% 3.6-3.6 573,370
2006-2007 3.6% 3.6-3.6 588,910
2007-2008 3.5% 3.5-3.6 600,790
2008-2009 3.5% 3.5-3.6 615,900
2009-2010 3.5% 3.5-3.5 629,380
2010-2011 3.5% 3.5-3.5 643,320

Fiscal Year Prevalence 95% Confidence Interval Number of people
2011-2012 3.5% 3.4-3.5 655,760

2012-2013 3.4% 3.4-3.4 669,620
2.1.2 Incidence (new cases)

The age-standardized incidence rate of IHD decreased from 12.3 per 1,000 in 2000–2001 to 6.8 per 1,000 in 2012–2013,
with an AAPC of -4.6%. The age-standardized occurrence rate of a first AMI also declined, from 3.0 per 1,000 in 2000–
2001 to 2.2 per 1,000 in 2012–2013, with an AAPC of -1.8% (Figure 2A).
The number of people newly diagnosed with IHD declined from about 221,800 to 158,700 between 2000–2001 and
2012–2013. However, the number of people having a first AMI remained relatively stable at about 62,000 people
annually (Figure 2A).
The age-standardized incidence rate of heart failure declined from 8.1 per 1,000 to 5.3 per 1,000 between 2000–2001
and 2012–2013, with an AAPC of -3.1%. Over the same period, the number of people newly diagnosed with heart failure
fell from about 102,800 to 92,900 individuals (Figure 2B).
Text Description
Heart disease incidence rates declined in Canada between 2000–2001 and 2012–2013. Rates declined by 45% for IHD,
17% for AMI (a subset of IHD) and by 35% for heart failure.
Figure 2A. Incidence (rates † and number) of diagnosed ischemic heart disease (IHD) and occurrence (rates †and number)
of first acute myocardial infarction (AMI) among Canadians aged 20 years and older, Canada *, 2000–2001 to 2012–2013
Figure 2A. Incidence (rates † and number) of diagnosed ischemic heart disease (IHD) and occurrence
(rates † and number) of first acute myocardial infarction (AMI) among Canadians aged 20 years and
older, Canada *, 2000–2001 to 2012–2013
IHD 95% 95% Number of people
Fiscal incidence Confidence Occurrence first Confidence with newly diagnosed Number of people with
Year rate Interval AMI (IHD subset) Interval IHD new AMI (IHD subset)

2000- 12.3 per 12.3-12.4 3.0 per 1,000 3.0-3.0 221,790 62,740
2001 1,000 people
people
2001- 11.5 per 11.4-11.5 2.9 per 1,000 2.9-3.0 209,220 63,450
2002 1,000 people
people
2002- 10.7 per 10.6-10.7 2.9 per 1,000 2.9-2.9 199,000 63,850
2003 1,000 people
people
2003- 10.1 per 10.0-10.1 2.9 per 1,000 2.8-2.9 191,480 64,530
2004 1,000 people
people
2004- 9.6 per 9.5-9.6 2.7 per 1,000 2.7-2.8 185,330 63,060
2005 1,000 people
people
2005- 9.1 per 9.1-9.2 2.6 per 1,000 2.6-2.6 180,330 61,770
2006 1,000 people
people
2006- 8.6 per 8.6-8.7 2.5 per 1,000 2.5-2.5 174,240 59,810
2007 1,000 people
people
2007- 8.2 per 8.2-8.3 2.5 per 1,000 2.5-2.5 169,480 61,200
2008 1,000 people
people
2008- 8.0 per 7.9-8.0 2.4 per 1,000 2.4-2.4 167,490 60,720
2009 1,000 people
people
2009- 7.6 per 7.6-7.7 2.3 per 1,000 2.3-2.3 164,640 60,030
2010 1,000 people
people
2010- 7.4 per 7.3-7.4 2.3 per 1,000 2.3-2.3 163,470 61,120
2011 1,000 people
people
2011- 7.1 per 7.1-7.1 2.2 per 1,000 2.2-2.3 162,130 61,340
2012 1,000 people
people

2012- 6.8 per 6.7-6.8 2.2 per 1,000 2.2-2.3 158,720 63,190
2013 1,000 people
people
Figure 2B. Age-standardized † incidence rates of diagnosed heart failure and number of people with heart failure, among
Canadians aged 40 years and older, Canada *, 2000–2001 to 2012–2013
Figure 2B. Age-standardized † incidence rates of diagnosed heart failure and number of people with
heart failure, among Canadians aged 40 years and older, Canada *, 2000–2001 to 2012–2013
Fiscal Year Incidence rate 95% Confidence Interval Number of people
2000-2001 8.1 per 1,000 people 8.1-8.2 102,830
2001-2002 7.7 per 1,000 people 7.6-7.7 99,070

2002-2003 7.1 per 1,000 people 7.1-7.2 94,130
2003-2004 6.9 per 1,000 people 6.8-6.9 93,320

2004-2005 6.6 per 1,000 people 6.5-6.6 91,580
2005-2006 6.3 per 1,000 people 6.2-6.3 90,170

2006-2007 6.0 per 1,000 people 6.0-6.1 89,120
2007-2008 5.8 per 1,000 people 5.8-5.9 88,710

2008-2009 5.9 per 1,000 people 5.8-5.9 91,720
2009-2010 5.7 per 1,000 people 5.7-5.7 91,570
2010-2011 5.5 per 1,000 people 5.5-5.5 90,940

2011-2012 5.4 per 1,000 people 5.4-5.4 91,990
2012-2013 5.3 per 1,000 people 5.2-5.3 92,850

2.1.3 All-Cause Mortality Rates
The age-standardized all-cause mortality rate among people living with IHD and those with a history of
AMI decreased substantially between 2000–2001 and 2012–2013, from 22.5 to 17.1 per 1,000 and from
42.2 to 27.5 per 1,000, respectively, with corresponding AAPCs of -1.3% and -2.9% (Figure 3A).
On the other hand, the absolute number of deaths has increased over time, from about 86,300 deaths
in 2000–2001 to 112,200 deaths in 2012–2013 in those with diagnosed IHD, including a rise in the
number of deaths among those with a history of AMI, from about 25,600 deaths to 41,500 deaths (Figure 3A). Overall,
all-cause deaths among those with a history of AMI represented over one third of all deaths in those with IHD.
The age-standardized all-cause mortality rate among people living with heart failure declined from 78.4 to 57.8 per
1,000 between 2000–2001 and 2012–2013, with an AAPC of -2.5%. The number of people with heart failure who died of
any cause increased from 67,300 in 2000–2001 to 80,100 in 2012–2013 (Figure 3B).
Text Description
Between 2000–2001 and 2012–2013, all-cause mortality rates declined by 24% among Canadians living with IHD, by
35% in those who had an AMI (a subset of IHD) and by 26% in those living with heart failure.
Figure 3A. Age-standardized † all-cause mortality rates and number of deaths among Canadians aged 20 years and older
with diagnosed ischemic heart disease (IHD) and those who had an acute myocardial infarction (AMI), Canada *, 2000–2001
to 2012–2013
Figure 3A. Age-standardized † all-cause mortality rates and number of deaths among Canadians aged
20 years and older with diagnosed ischemic heart disease (IHD) and those who had an acute
myocardial infarction (AMI), Canada *, 2000–2001 to 2012–2013
95% AMI all-cause 95% IHD -
Fiscal IHD all-cause Confidence mortality rate (IHD Confidence Number of AMI (IHD subset) -
Year mortality rate Interval subset) Interval deaths Number of deaths
2000- 22.5 per 1,000 22.1-23.0 42.2 per 1,000 people 41.0-43.4 86,340 25,600
2001 people
2001- 22.3 per 1,000 21.9-22.8 41.4 per 1,000 people 40.2-42.7 91,160 27,920
2002 people
2002- 21.4 per 1,000 21.1-21.8 37.7 per 1,000 people 36.7-38.8 94,930 29,970
2003 people
2003- 20.8 per 1,000 20.4-21.2 36.7 per 1,000 people 35.6-37.8 99,350 32,390
2004 people
2004- 19.5 per 1,000 19.2-19.8 33.9 per 1,000 people 33.0-34.9 99,390 33,590
2005 people
2005- 18.9 per 1,000 18.6-19.3 33.3 per 1,000 people 32.3-34.4 98,740 33,500
2006 people
2006- 18.9 per 1,000 18.6-19.3 31.1 per 1,000 people 30.2-32.1 103,110 34,950
2007 people
2007- 18.1 per 1,000 17.8-18.4 30.3 per 1,000 people 29.4-31.3 103,420 35,470
2008 people
2008- 18.2 per 1,000 17.9-18.6 30.2 per 1,000 people 29.2-31.2 106,560 37,000
2009 people
2009- 17.5 per 1,000 17.2-17.8 28.0 per 1,000 people 27.1-29.0 105,800 37,190
2010 people
2010- 17.4 per 1,000 17.1-17.7 28.2 per 1,000 people 27.3-29.2 109,710 38,940
2011 people
2011- 16.9 per 1,000 16.6-17.2 26.4 per 1,000 people 25.5-27.3 108,770 39,020
2012 people

95% AMI all-cause 95% IHD -
Fiscal IHD all-cause Confidence mortality rate (IHD Confidence Number of AMI (IHD subset) -
Year mortality rate Interval subset) Interval deaths Number of deaths
2012- 17.1 per 1,000 16.8-17.5 27.5 per 1,000 people 26.5-28.5 112,240 41,450
2013 people
Figure 3B. Age-standardized † all-cause mortality rates and number of deaths among Canadians aged 40 years and older
with diagnosed heart failure, Canada *, 2000–2001 to 2012–2013
Figure 3B: Age-standardized † all-cause mortality rates and number of deaths among Canadians aged
40 years and older with diagnosed heart failure, Canada *, 2000–2001 to 2012–2013
Fiscal Year All-cause mortality rate 95% Confidence Interval Number of deaths
2000-2001 78.4 per 1,000 people 76.8-80.1 67,300

2001-2002 77.0 per 1,000 people 75.4-78.6 69,550
2002-2003 73.2 per 1,000 people 71.6-74.8 70,730

2003-2004 71.6 per 1,000 people 70.1-73.1 74,030
2004-2005 68.1 per 1,000 people 66.7-69.6 73,740

2005-2006 66.1 per 1,000 people 64.6-67.5 71,860
2006-2007 63.7 per 1,000 people 62.4-65.1 75,040

2007-2008 63.6 per 1,000 people 62.3-65.0 74,410
2008-2009 61.8 per 1,000 people 60.5-63.1 76,280
2009-2010 59.5 per 1,000 people 58.3-60.8 75,640

2010-2011 59.4 per 1,000 people 58.2-60.7 78,160
2011-2012 57.4 per 1,000 people 56.2-58.6 77,520

2012-2013 57.8 per 1,000 people 56.6-59.1 80,050
Canadian adults with heart disease have higher mortality rates compared to those without heart disease
Compared to those without IHD, AMI or heart failure, individuals with the disease of interest are more likely to die of
any cause in a given year.
Age-standardized all-cause mortality rates were almost three times higher, on average, among Canadian adults with
diagnosed IHD compared to those without in a given year (Figure 4A).
Compared to those without a prior history of AMI, those with a history of AMI were about four times more likely to die
of any cause in 2012–2013 (Figure 4B). The gap between those with and without a history of AMI has reduced over
time, since the rate ratio was as high as 4.7 in the early 2000s.
In a given year, Canadians aged 40 years and older with diagnosed heart failure were, on average, six times more likely
to die of any cause than those without heart failure (Figure 4C).
Text Description
In any given year, Canadians with IHD, Canadians who had an AMI and those with heart failure are three, four and six
times more likely to die of any cause than those without these diseases, respectively.
Figure 4A. Age-standardized † all-cause mortality rates and rate ratios among Canadians aged 20 years and older with and
without ischemic heart disease (IHD), Canada *, 2000–2001 to 2012–2013
Figure 4A: Age-standardized † all-cause mortality rates and rate ratios among Canadians aged 20
years and older with and without ischemic heart disease (IHD), Canada *, 2000–2001 to 2012–2013
Fiscal 95% Confidence 95% Confidence Rate 95% Confidence
Year With IHD Interval Without IHD Interval ratio Interval
2000- 22.5 per 1,000 22.1-23.0 7.6 per 1,000 7.6-7.7 2.9 2.9 - 3.0
2001 people people
2001- 22.3 per 1,000 21.9-22.8 7.5 per 1,000 7.4-7.5 3.0 2.9 - 3.1
2002 people people
2002- 21.4 per 1,000 21.1-21.8 7.3 per 1,000 7.3-7.4 2.9 2.9 - 3.0
2003 people people
2003- 20.8 per 1,000 20.4-21.2 7.3 per 1,000 7.3-7.3 2.8 2.8 -2.9
2004 people people
2004- 19.5 per 1,000 19.2-19.8 7.1 per 1,000 7.0-7.1 2.8 2.7 -2.8
2005 people people
2005- 18.9 per 1,000 18.6-19.3 6.8 per 1,000 6.7-6.8 2.8 2.7 -2.9
2006 people people
2006- 18.9 per 1,000 18.6-19.3 6.8 per 1,000 6.8-6.8 2.8 2.7 -2.8
2007 people people
2007- 18.1 per 1,000 17.8-18.4 6.6 per 1,000 6.6-6.7 2.7 2.7 -2.8
2008 people people
2008- 18.2 per 1,000 17.9-18.6 6.5 per 1,000 6.5-6.6 2.8 2.7 -2.8
2009 people people
2009- 17.5 per 1,000 17.2-17.8 6.4 per 1,000 6.3-6.4 2.8 2.7 -2.8
2010 people people
2010- 17.4 per 1,000 17.1-17.7 6.4 per 1,000 6.3-6.4 2.7 2.7 -2.8
2011 people people
2011- 16.9 per 1,000 16.6-17.2 6.1 per 1,000 6.1-6.2 2.8 2.7 -2.8
2012 people people
2012- 17.1 per 1,000 16.8-17.5 6.1 per 1,000 6.1-6.2 2.8 2.7 -2.8
2013 people people
Figure 4B. Age-standardized † all-cause mortality rates and rate ratios among Canadians aged 20 years and older with and
without acute myocardial infarction (AMI), Canada *, 2000–2001 to 2012–2013
Figure 4B: Age-standardized † all-cause mortality rates and rate ratios among Canadians aged 20
years and older with and without acute myocardial infarction (AMI), Canada *, 2000–2001 to 2012–
2013
Fiscal With AMI (IHD 95% Confidence 95% Confidence Rate 95% Confidence
Year subset) Interval Without AMI Interval ratio Interval
Fiscal With AMI (IHD 95% Confidence 95% Confidence Rate 95% Confidence
Year subset) Interval Without AMI Interval ratio Interval
2000- 42.2 per 1,000 41.0-43.4 9.0 per 1,000 9.0-9.1 4.7 4.5 - 4.8
2001 people people
2001- 41.4 per 1,000 40.2-42.7 8.9 per 1,000 8.8-8.9 4.7 4.5 - 4.8
2002 people people
2002- 37.7 per 1,000 36.7-38.8 8.7 per 1,000 8.7-8.8 4.3 4.2 - 4.4
2003 people people
2003- 36.7 per 1,000 35.6-37.8 8.7 per 1,000 8.7-8.7 4.2 4.1 - 4.3
2004 people people
2004- 33.9 per 1,000 33.0-34.9 8.4 per 1,000 8.3-8.4 4.0 3.9 - 4.2
2005 people people
2005- 33.3 per 1,000 32.3-34.4 8.0 per 1,000 8.0-8.1 4.2 4.0 - 4.3
2006 people people
2006- 31.1 per 1,000 30.2-32.1 8.1 per 1,000 8.0-8.1 3.9 3.7 - 4.0
2007 people people
2007- 30.3 per 1,000 29.4-31.3 7.9 per 1,000 7.8-7.9 3.9 3.7 - 4.0
2008 people people
2008- 30.2 per 1,000 29.2-31.2 7.8 per 1,000 7.7-7.8 3.9 3.8 - 4.0
2009 people people
2009- 28.0 per 1,000 27.1-29.0 7.5 per 1,000 7.5-7.5 3.7 3.6 - 3.9
2010 people people
2010- 28.2 per 1,000 27.3-29.2 7.5 per 1,000 7.5-7.5 3.8 3.6 - 3.9
2011 people people
2011- 26.4 per 1,000 25.5-27.3 7.2 per 1,000 7.2-7.2 3.7 3.5 - 3.8
2012 people people
2012- 27.5 per 1,000 26.5-28.5 7.2 per 1,000 7.2-7.2 3.8 3.7 - 4.0
2013 people people
Figure 4C. Age-standardized † all-cause mortality rates and rate ratios among Canadians aged 40 years and older with and
without heart failure, Canada *, 2000–2001 to 2012–2013
Figure 4C. Text description follows.
Figure 4C: Age-standardized † all-cause mortality rates and rate ratios among Canadians aged 40
years and older with and without heart failure, Canada *, 2000–2001 to 2012–2013
Fiscal With heart 95% Confidence Without heart 95% Confidence Rate 95% Confidence
Year failure Interval failure Interval ratio Interval

Fiscal With heart 95% Confidence Without heart 95% Confidence Rate 95% Confidence
Year failure Interval failure Interval ratio Interval
2000- 78.4 per 1,000 76.8-80.1 11.5 per 1,000 11.4-11.5 6.8 6.7-7.0
2001 people people
2001- 77.0 per 1,000 75.4-78.6 11.2 per 1,000 11.2-11.3 6.9 6.7-7.0
2002 people people
2002- 73.2 per 1,000 71.6-74.8 11.1 per 1,000 11.1-11.2 6.6 6.4-6.7
2003 people people
2003- 71.6 per 1,000 70.1-73.1 11.0 per 1,000 11.0-11.1 6.5 6.3-6.6
2004 people people
2004- 68.1 per 1,000 66.7-69.6 10.7 per 1,000 10.6-10.7 6.4 6.3-6.5
2005 people people
2005- 66.1 per 1,000 64.6-67.5 10.2 per 1,000 10.2-10.3 6.5 6.3-6.6
2006 people people
2006- 63.7 per 1,000 62.4-65.1 10.3 per 1,000 10.2-10.3 6.2 6.1-6.3
2007 people people
2007- 63.6 per 1,000 62.3-65.0 10.0 per 1,000 10.0-10.1 6.3 6.2-6.5
2008 people people
2008- 61.8 per 1,000 60.5-63.1 9.9 per 1,000 9.9-10.0 6.2 6.1-6.4
2009 people people
2009- 59.5 per 1,000 58.3-60.8 9.6 per 1,000 9.6-9.7 6.2 6.1-6.3
2010 people people
2010- 59.4 per 1,000 58.2-60.7 9.6 per 1,000 9.6-9.7 6.2 6.0-6.3
2011 people people
2011- 57.4 per 1,000 56.2-58.6 9.3 per 1,000 9.2-9.3 6.2 6.1-6.3
2012 people people
2012- 57.8 per 1,000 56.6-59.1 9.3 per 1,000 9.2-9.3 6.2 6.1-6.4
2013 people people
Multiple factors explain improved cardiovascular health

Between 2000–2001 and 2012–2013, age-standardized incidence (occurrence in the case of AMI) and all-cause mortality
rates have declined greatly among those with IHD and heart failure and those having had an AMI.
Using a validated mortality model, Ford E. et al. quantified the respective contribution of major risk factors and medical
treatments to the decline in mortality from coronary heart disease between 1980 and 2000, among American adults aged
25 to 84 years old. About 47% of this decline in mortality was attributed to treatments, including medications or
rehabilitation, after an AMI. Approximately 44% of the decline was also attributed to changes in risk factors, namely
decreases in total cholesterol, systolic blood pressure and smoking. 9 Similar studies conducted in Western countries found
that trends in risk factors explained 44% to 76% of the decline whereas treatments explained 23% to 47%. 10
Use of aspirin, antihypertensive medications and cholesterol-lowering medications (such as statins) reduce the risk of
developing heart disease. 11, 12 In addition, the effectiveness of cardiac drugs to relieve symptoms and prevent recurrent
AMI and premature death has been well documented. 13, 14, 15 Improvements in cardiac care and use of surgical
treatments, mainly coronary artery bypass surgery, has also been shown to reduce all-cause mortality rates and ischemic
heart disease events. 16
In the INTERHEART study, it was found that nine risk factors (smoking, high cholesterol, hypertension, diabetes, abdominal
obesity, psychosocial factors, low consumption of fruits and vegetables, regular alcohol consumption and physical
inactivity) accounted for 90% of the risk of developing AMI. 17 Together, smoking and high cholesterol alone accounted for
two thirds of the risk worldwide.
In Canada, the proportion of people aged 15 years and older who self-reported smoking (daily or occasionally) decreased
from 25.2% in 1999 to 13.0% in 2015.18 However, based on directly measured data, the proportion of people aged 18 to 79
years who have elevated cholesterol remains high at 18.7%, with a greater proportion of men (29.8%) than women (7.8%)
affected. 18
The decline in the incidence of hypertension in Canada has likely contributed in part to the decline in IHD and heart failure
incidence and all-cause mortality. For instance, from 2000–2001 to 2012–2013, agestandardized incidence rate of diagnosed
hypertension decreased from 32.1 to 21.8 per 1,000. 19 Moreover, Canada has one of the highest proportions of
hypertension control in the world, with about 68% of hypertensive adults being treated and controlled. 20
On the other hand, the absolute number of people living with IHD and heart failure and those with a history of AMI
increased, indicating better survival, mostly due to increased awareness of warning signs and risk factors for heart disease
and improvements in risk factor reduction, disease management and treatment. 9, 21
The absolute number of deaths increased in those with IHD and heart failure and those who had an AMI, a trend which
may be due to population growth and aging. Similar patterns are observed in high-income regions throughout the world,
with the increase in cardiovascular disease deaths being attributed to the aging of the population (55%) and population
growth (25%). 22
2.2. Heart disease in men and women
2.2.1 Prevalence
The age-standardized prevalence of IHD and heart failure and AMI occurrence were higher among men than women
over the surveillance period (Figures 5A and 5B). This difference by sex was more pronounced for AMI, where the age-
standardized occurrence was about 2.5 times higher among men than women, on average, from 2000–2001 to 2012–
2013. This difference has slowly increased over time.
IHD and heart failure prevalence as well as AMI occurrence increased with age for both women and men. The gap
between the sexes narrows with age (Figures 6A and 6B).
Figure 5A. Prevalence (% † and number) of diagnosed ischemic heart disease (IHD) and occurrence (% † and number) of
acute myocardial infarction (AMI) among Canadians aged 20 years and older, by sex, Canada *, 2000–2001 to 2012–2013
Figure 5A: Prevalence (% † and number) of diagnosed ischemic heart disease (IHD) and occurrence (%
†
and number) of acute myocardial infarction (AMI) among Canadians aged 20 years and older, by
sex, Canada *, 2000–2001 to 2012–2013
95% 95% 95% 95%
Fiscal Men Confidence Women Confidence Men–AMI Confidence Women–AMI Confidence
Year (IHD) Interval (IHD) Interval (IHD subset) Interval (IHD subset) Interval
2000- 8.8% 8.8-8.9 5.7% 5.6-5.7 1.7% 1.7-1.7 0.7% 0.7-0.7

2001

95% 95% 95% 95%
Fiscal Men Confidence Women Confidence Men–AMI Confidence Women–AMI Confidence
Year (IHD) Interval (IHD) Interval (IHD subset) Interval (IHD subset) Interval
2001- 9.2% 9.2-9.2 6.0% 5.9-6.0 1.9% 1.9-1.9 0.8% 0.8-0.8

2002
2002- 9.5% 9.5-9.5 6.2% 6.2-6.2 2.1% 2.1-2.1 0.9% 0.9-0.9

2003
2003- 9.7% 9.7-9.7 6.3% 6.3-6.3 2.2% 2.3-2.3 0.9% 0.9-0.9

2004
2004- 9.9% 9.9-9.9 6.4% 6.4-6.5 2.4% 2.4-2.4 1.0% 1.0-1.0

2005
2005- 10.0% 10.0-10.1 6.5% 6.5-6.5 2.5% 2.5-2.5 1.0% 1.0-1.1

2006
2006- 10.1% 10.1-10.2 6.6% 6.5-6.6 2.6% 2.6-2.6 1.0% 1.0-1.2

2007
2007- 10.2% 10.2-10.2 6.6% 6.5-6.6 2.7% 2.7-2.7 1.1% 1.0-1.1

2008
2008- 10.3% 10.2-10.3 6.6% 6.6-6.6 2.7% 2.7-2.8 1.1% 1.1-1.1

2009
2009- 10.2% 10.2-10.3 6.5% 6.5-6.5 2.8% 2.8-2.8 1.1% 1.1-1.1

2010
2010- 10.2% 10.2-10.2 6.5% 6.5-6.5 2.8% 2.8-2.8 1.1% 1.1-1.1

2011
2011- 10.1% 10.1-10.1 6.4% 6.4-6.4 2.9% 2.9-2.9 1.1% 1.1-1.1

2012
2012- 10.0% 10.0-10.0 6.3% 6.3-6.3 2.9% 2.9-2.9 1.1% 1.1-1.1

2013
Figure 5B. Age-standardized † prevalence of diagnosed heart failure among Canadians aged 40 years and older, by sex,
Canada *, 2000–2001 to 2012–2013
Figure 5B: Age-standardized † prevalence of diagnosed heart failure among Canadians aged 40 years
and older, by sex, Canada *, 2000–2001 to 2012–2013
Fiscal Year Men (heart failure) 95% Confidence Interval Women (heart failure) 95% Confidence Interval
2000-2001 3.9% 3.9-3.9 3.0% 2.9-3.0
2001-2002 4.0% 4.0-4.0 3.1% 3.1-3.1
2002-2003 4.1% 4.1-4.1 3.1% 3.1-3.1
2003-2004 4.1% 4.1-4.1 3.1% 3.1-3.2

2004-2005 4.1% 4.1-4.2 3.1% 3.1-3.2
2005-2006 4.1% 4.1-4.1 3.1% 3.1-3.1
2006-2007 4.1% 4.1-4.1 3.1% 3.1-3.1
2007-2008 4.1% 4.1-4.1 3.1% 3.1-3.1

2008-2009 4.1% 4.1-4.1 3.1% 3.1-3.1
2009-2010 4.1% 4.1-4.1 3.0% 3.0-3.0
2010-2011 4.1% 4.0-4.1 3.0% 3.0-3.0
2011-2012 4.0% 4.0-4.0 3.0% 2.9-3.0
2012-2013 4.0% 4.0-4.0 2.9% 2.9-2.9

Figure 6A. Prevalence of diagnosed ischemic heart disease (IHD) and occurrence of acute myocardial infarction (AMI)
among Canadians aged 20 years and older, by age group and sex, Canada *, 2000–2001 to 2012–2013

Figure 6A: Prevalence of diagnosed ischemic heart disease (IHD) and occurrence of acute myocardial
infarction (AMI) among Canadians aged 20 years and older, by age group and sex, Canada *, 2000–
2001 to 2012–2013
Age 95% 95% Men – AMI 95% 95%
Group Men Confidence Women Confidence (IHD Confidence Women – AMI Confidence
(Years) (IHD) Interval (IHD) Interval subset) Interval (IHD Subset) Interval
20–39 0.4% 0.4-0.4 0.4% 0.4-0.4 0.1% 0.1-0.1 0.0% 0.0-0.0
40-54 4.2% 4.1-4.2 2.3% 2.3-2.3 1.3% 1.2-1.3 0.3% 0.3-0.3
55-64 13.6% 13.6-13.7 7.3% 7.3-7.4 4.3% 4.3-4.3 1.2% 1.2-1.2
65-74 26.8% 26.7-26.9 16.1% 16.0-16.1 7.6% 7.6-7.7 2.6% 2.6-2.7
75-84 40.9% 40.8-41.0 28.3% 28.2-28.4 11.0% 10.9-11.0 5.4% 5.3-5.4

85+ 47.9% 47.6-48.1 38.5% 38.3-38.7 13.7% 13.6-13.9 9.0% 9.0-9.1
Figure 6B. Prevalence of diagnosed heart failure among Canadians aged 40 years and older, by age group and sex, Canada
*, 2012–2013
Figure 6B: Prevalence of diagnosed heart failure among Canadians aged 40 years and older, by age
group and sex, Canada *, 2012–2013
Age Group Men (heart 95% Confidence Women (heart 95% Confidence
(Years) failure) Interval failure) Interval
40-54 0.5% 0.5-0.5 0.3% 0.3-0.3

55-64 2.3% 2.3-2.3 1.4% 1.3-1.4
65-74 6.0% 6.0-6.1 3.8% 3.8-3.8
75-84 13.6% 13.5-13.6 10.3% 10.3-10.4
85+ 24.4% 24.2-24.5 22.3% 22.2-22.4

Age-standardized incidence rates of IHD and heart failure and occurrence rates of first AMI were higher among men
than women across the 13-year period (Figures 7A and 7B). The difference by sex was more pronounced for AMI, with
rates about 2.1 times higher, on average, among men than among women.
IHD and heart failure incidence rates as well as occurrence rates of first AMI increased with age for both women and
men (Figures 8A and 8B). Women tend to develop heart disease about 10 years later than men, but the gap between
the sexes decreases as they get older.
Figure 7A. Incidence (rates † of diagnosed ischemic heart disease (IHD) and occurrence (rates † of first acute myocardial
infarction (AMI) among Canadians aged 20 years and older, by sex, Canada *, 2000–2001 to 2012–2013
Figure 7A: Incidence (rates † of diagnosed ischemic heart disease (IHD) and occurrence (rates † of
first acute myocardial infarction (AMI) among Canadians aged 20 years and older, by sex, Canada *,
2000–2001 to 2012–2013.
95% 95% Men – AMI 95% 95%
Fiscal Men Confidence Women Confidence (IHD Confidence Women – AMI Confidence
Year (IHD) Interval (IHD) Interval subset) Interval (IHD subset) Interval
95% 95% Men – AMI 95% 95%
2000- 15.1 per 15.1-15.2 10.1 per 10.0-10.1 4.2 per 1,000 4.2-4.3 1.9 per 1,000 1.9-2.0
2001 1,000 1,000 people people
people people
2001- 14.0 per 13.9-14.1 9.4 per 9.4-9.5 4.1 per 1,000 4.1-4.2 2.0 per 1,000 1.9-2.0
people people
2002- 13.1 per 13.1-13.2 8.7 per 8.6-8.7 4.1 per 1,000 4.0-4.1 1.9 per 1,000 1.9-1.9
people people
2003- 12.5 per 12.4-12.5 8.2 per 8.1-8.2 4.0 per 1,000 4.0-4.0 1.9 per 1,000 1.9-1.9
people people
2004- 11.9 per 11.9-12.0 7.7 per 7.6-7.7 3.8 per 1,000 3.8-3.9 1.8 per 1,000 1.8-1.8
people people
2005- 11.5 per 11.4-11.5 7.2 per 7.2-7.3 3.6 per 1,000 3.6-3.7 1.8 per 1,000 1.7-1.8
people people
2006- 10.9 per 10.8-10.9 6.8 per 6.8-6.9 3.4 per 1,000 3.4-3.5 1.6 per 1,000 1.6-1.7
people people
2007- 10.4 per 10.4-10.5 6.4 per 6.4-6.5 3.5 per 1,000 3.4-3.5 1.6 per 1,000 1.6-1.6
people people
2008- 10.1 per 10.0-10.2 6.2 per 6.2-6.3 3.4 per 1,000 3.3-3.4 1.6 per 1,000 1.5-1.5
people people
2009- 9.6 per 9.5-9.7 6.0 per 6.0-6.1 3.3 per 1,000 3.2-3.3 1.5 per 1,000 1.5-1.5
people people
2010- 9.3 per 9.3-9.4 5.8 per 5.7-5.8 3.2 per 1,000 3.2-3.2 1.5 per 1,000 1.5-1.5
people people
2011- 9.0 per 9.0-9.1 5.5 per 5.5-5.6 3.1 per 1,000 3.1-3.1 1.5 per 1,000 1.5-1.5
people people

95% 95% Men – AMI 95% 95%
2012- 8.6 per 8.6-8.7 5.2 per 5.2-5.3 3.1 per 1,000 3.1-3.1 1.5 per 1,000 1.5-1.5
people people
Figure 7B. Age-standardized † incidence rates of diagnosed heart failure among Canadians aged 40 years and older, by sex,
Canada *, 2000–2001 to 2012–2013
Figure 7B: Age-standardized † incidence rates of diagnosed heart failure among Canadians aged 40
years and older, by sex, Canada *, 2000–2001 to 2012–2013.
2000-2001 9.6 per 1,000 people 9.5-9.7 7.0 per 1,000 people 7.0-7.1
Figure 8A. Incidence rates of diagnosed ischemic heart disease (IHD) and occurrence rates of first acute myocardial
infarction (AMI) among Canadians aged 20 years and older, by age group and sex, Canada *, 2012–2013
Figure 8A: Incidence rates of diagnosed ischemic heart disease (IHD) and occurrence rates of first
acute myocardial infarction (AMI) among Canadians aged 20 years and older, by age group and sex,
Canada *, 2012–2013
Age 95% 95% Men – AMI 95% Women – 95%
Group Men Confidence Women Confidence (IHD Confidence AMI (IHD Confidence
(Years) (IHD) Interval (IHD) Interval subset) Interval subset) Interval
Age 95% 95% Men – AMI 95% Women – 95%
Group Men Confidence Women Confidence (IHD Confidence AMI (IHD Confidence
(Years) (IHD) Interval (IHD) Interval subset) Interval subset) Interval
20–39 0.6 0.6-0.7 0.4 per 0.4-0.4 0.1 per 0.1-0.1 0.0 per 1,000 0.0-0.0
per1,000 1,000 1,000 people
people people
40-54 4.8 per 4.8-4.9 2.5 per 2.5-2.6 1.7 per 1.7-1.8 0.5 per 1,000 0.5-0.5
1,000 1,000 1,000 people
people people people
55-64 12.1 per 12.0-12.3 6.3 per 6.2-6.4 4.2 per 4.1-4.3 1.4 per 1,000 1.4-1.5
1,000 1,000 1,000 people
65-74 20.8 per 20.6-21.1 12.1 per 11.9-12.3 6.8 per 6.6-6.9 3.2 per 1,000 3.1-3.3
1,000 1,000 1,000 people
75-84 31.3 per 30.8-31.8 21.0 per 20.6-21.3 11.5 per 11.3-11.8 7.1 per 1,000 6.9-7.3
1,000 1,000 1,000 people
85+ 39.1 per 38.1-40.1 31.5 per 30.9-32.0 18.8 per 18.2-19.3 14.0 per 1,000 13.7-14.3
1,000 1,000 1,000 people
Figure 8B. Incidence rates of diagnosed heart failure among Canadians aged 40 years and older, by age group and sex,
Canada *, 2012–2013
Figure 8B: Incidence rates of diagnosed heart failure among Canadians aged 40 years and older, by
age group and sex, Canada *, 2012–2013
Age Group 95% Confidence
(Years) Men (IHD) Interval Women (IHD) 95% Confidence Interval
Age Group 95% Confidence
(Years) Men (IHD) Interval Women (IHD) 95% Confidence Interval
75-84 21.0 per 1,000 20.7-21.4 15.6 per 1,000 15.4-15.9

people people
85+ 44.5 per 1,000 43.6-45.3 37.7 per 1,000 37.2-38.3

people people
2.2.3 All-Cause Mortality Rates

Overall, age-standardized all-cause mortality rates among those with diagnosed IHD were slightly higher among men
than women from 2000–2001 to 2012–2013 (Figure 9A). Relative declines of 22.3% and 25.9% were seen for women and
men, respectively, over the 13-year period.
For those with a prior history of AMI, all-cause mortality rates were higher in women than men in any given year. The
age-standardized rate per 1,000 fell from 51.3 to 31.7 among women and from 40.2 to 26.3 among men between 2000–
2001 and 2012–2013, with relative decreases of 38.2% and 34.7%, respectively (Figure 9A).
As for heart failure, women and men had similar age-standardized all-cause mortality rates over time, as indicated by
overlapping confidence intervals (Figure 9B). Rates fell for both women and men over time, with relative decreases of
24.2% and 28.2%, respectively.
Figure 9A. Age-standardized † all-cause mortality rates among Canadians aged 20 years and older with diagnosed ischemic
heart disease (IHD) and acute myocardial infarction (AMI), by sex, Canada *, 2000–2001 to 2012–2013
Figure 9A: Age-standardized † incidence rates of diagnosed heart failure among Canadians aged 40
years and older, by sex, Canada *, 2000–2001 to 2012–2013.
95% 95% Men – AMI 95% 95%
2000- 24.6 per 24.1-25.2 20.2 per 19.6-21.0 40.2 per 39.0-41.6 51.3 per 1,000 47.9-55.1
2001 1,000 1,000 1,000 people people
people people
2001- 24.5 per 24.0-25.1 19.9 per 19.2-20.6 39.1 per 37.9-40.4 52.2 per 1,000 49.3-56.9
2002 1,000 1,000 1,000 people people
people people
2002- 23.2 per 22.7-23.8 19.5 per 18.9-20.1 35.7 per 34.6-36.8 47.6 per 1,000 44.4-51.2
2003 1,000 1,000 1,000 people people
people people
2003- 22.9 per 22.4-23.4 18.4 per 17.9-19.0 35.5 per 34.4-36.7 42.6 per 1,000 39.9-45.6
2004 1,000 1,000 1,000 people people
people people
95% 95% Men – AMI 95% 95%
2004- 21.2 per 20.7-21.6 17.6 per 17.1-18.1 32.5 per 31.5-33.6 40.6 per 1,000 37.9-43.6
2005 1,000 1,000 1,000 people people
people people
2005- 20.5 per 20.1-21.0 17.1 per 16.6-17.6 31.2 per 30.1-32.4 42.1 per 1,000 39.1-45.4
2006 1,000 1,000 1,000 people people
people people
2006- 20.5 per 20.1-21.0 17.1 per 16.6-17.6 29.7 per 28.7-30.8 37.4 per 1,000 34.9-40.2
2007 1,000 1,000 1,000 people people
people people
2007- 19.6 per 19.1-20.0 16.4 per 16.0-16.9 28.7 per 27.7-29.8 37.6 per 1,000 34.8-40.6
2008 1,000 1,000 1,000 people people
people people
2008- 19.6 per 19.1-20.1 16.6 per 16.1-17.1 28.6 per 27.5-29.7 37.0 per 1,000 34.2-40.0
2009 1,000 1,000 1,000 people people
people people
2009- 18.9 per 18.4-19.3 16.0 per 15.5-16.4 26.2 per 25.3-27.2 35.1 per 1,000 32.5-38.1
2010 1,000 1,000 1,000 people people
people people
2010- 18.5 per 18.1-19.0 16.0 per 15.6-16.5 26.4 per 25.4-27.4 35.4 per 1,000 32.8-38.3
2011 1,000 1,000 1,000 people people
people people
2011- 17.8 per 17.4-18.2 15.7 per 15.3-16.2 24.2 per 23.3-25.1 34.5 per 1,000 31.8-37.6
2012 1,000 1,000 1,000 people people
people people
2012- 18.3 per 17.8-18.7 15.7 per 15.3-16.2 26.3 per 25.2-27.4 31.7 per 1,000 29.4-34.3
2013 1,000 1,000 1,000 people people
people people
Figure 9B. Age-standardized † all-cause mortality rates among Canadians aged 40 years and older with diagnosed heart
failure, by sex, Canada *, 2000–2001 to 2012–2013
Figure 9B: Age-standardized † all-cause mortality rates among Canadians aged 40 years and older
with diagnosed heart failure, by sex, Canada *, 2000–2001 to 2012–2013.
Overall in 2012–2013, men with diagnosed IHD were, on average, 1.2 times more likely to die of any cause than women
with diagnosed IHD (Figure 10A) during the year. Younger women and men, aged 20 to 39 years, with diagnosed IHD
were about 17.6 and 10.9 times more likely to die, respectively, than those without the disease (Figure 10A). As age
increased, mortality rate ratios decreased considerably; it was down to 1.7 for both women and men aged 85 years and
older.
Overall, in 2012–2013, women with a prior AMI were, on average, 1.3 times more likely to die of any cause compared
with men who had a prior AMI. Higher mortality rates observed among women aged 45 to 74 years old drive this
difference (Figure 10B).
In 2012–2013, women aged 20 to 44 years with a prior AMI were about 27.6 times more likely to die of any cause
compared to those without. This result should be interpreted with caution however since the confidence interval is
wide in this age group. Men of the same age with a prior AMI were about 15.6 times more likely to die of any cause
than men without in 2012–2013. As age increased, mortality rate ratios decreased to the point that both women and
men had similar rate ratios (Figure 10B).
In 2011–2012, all-cause mortality rates 365 days following a hospitalization with a recorded history of AMI were higher
in women than in men aged 20 to 74 years old. Rates ranged respectively from 60.0 to 194.7 per 1,000 and from 20.9 to
175.0 per 1,000. Starting at age 75, men had higher rates than women (Figure 10C).
Starting at age 65, all-cause mortality rates were higher among men with diagnosed heart failure than among women
of the same age with the disease in 2012–2013 (Figure 10D).
In 2012–2013, women and men aged 40 to 54 years old with diagnosed heart failure were 27.3 and 16.5 times more
likely to die of any cause during the year, respectively, than those without the disease. As age increased, mortality rate
ratios decreased down to 2.6 for both women and men aged 85 years and older (Figure 10D).
Figure 10A. All-cause mortality rates and rate ratios among Canadians aged 20 years and older with diagnosed ischemic
heart disease (IHD) compared to those without, by age group and sex, Canada *, 2000–2001 to 2012–2013
Figure 10A: All-cause mortality rates and rate ratios among Canadians aged 20 years and older with diagn
heart disease (IHD) compared to those without, by age group and sex, Canada *, 2012–2013.
Men 95% Women 95% Men 95% Women 95% Rate 95% Rate
Age with Confidence with Confidence without Confidence without Confidence ratio Confidence ratio
group IHD Interval IHD Interval IHD Interval IHD Interval (men) Interval (wom
Source: Public Health Agency of Canada, using Canadian Chronic Disease Surveillance System data files contributed by provinces and territor

Men 95% Women 95% Men 95% Women 95% Rate 95% Rate
Age with Confidence with Confidence without Confidence without Confidence ratio Confidence ratio
group IHD Interval IHD Interval IHD Interval IHD Interval (men) Interval (wom
20–39 7.7 per 6.6-9.0 6.2 per 5.1-7.5 0.7 per 0.7-0.7 0.4 per 0.3-0.4 10.9 9.3 - 12.8 17
1,000 1,000 1,000 1,000
people people people people
40-54 8.6 per 8.2-9.1 8.1 per 7.5-8.7 2.0 per 1.9-2.0 1.4 per 1.4-1.4 4.3 4.1 - 4.6 5
1,000 1,000 1,000 1,000
people people people people
55-64 15.0 14.6-15.4 13.5 per 13.0-14.1 5.6 per 5.5-5.7 3.7 per 3.6-3.8 2.7 2.6 - 2.8 3
per 1,000 1,000 1,000
1,000 people people people
people
65-74 28.6 28.1-29.1 24.0 per 23.4-24.6 12.1 per 11.8-12.3 8.3 per 8.2-8.5 2.4 2.3 - 2.4 2
per 1,000 1,000 1,000
people
75-84 63.8 62.9-64.7 52.0 per 51.2-52.9 32.7 per 32.2-33.3 23.4 per 23.0-23.8 1.9 1.9 - 2.0 2
per 1,000 1,000 1,000
people
85+ 152.2 150.1-154.2 139.3 137.8-140.9 88.8 per 87.3-90.3 79.8 per 78.9-80.8 1.7 1.7 - 1.8 1
per per 1,000 1,000
1,000 1,000 people people
people people
Figure 10B. All-cause mortality rates and rate ratios among Canadians aged 20 years and older who had an acute
myocardial infarction (AMI) compared to those without, by age group and sex, Canada *, 2012–2013
a Interpret with caution, coefficient of variation between 16.6% and 33.3%.
Figure 10B: All-cause mortality rates and rate ratios among Canadians aged 20 years and older who had a
myocardial infarction (AMI) compared to those without, by age group and sex, Canada *, 2012–2013.
Men Women
with with
AMI 95% AMI 95% Men 95% Women 95% Rate 95% Rat
Age (IHD Confidence (IHD Confidence without Confidence without Confidence ratio Confidence rati
group subset) Interval subset) Interval AMI Interval AMI Interval (men) Interval (wo
20-44 13.0 10.8-15.6 12.9 per 8.7-18.5 0.8 per 0.8-0.9 0.5 per 0.5-0.5 15.6 13.0-18.7 27
per 1,000 1,000 1,000
people

Men Women
with with
AMI 95% AMI 95% Men 95% Women 95% Rate 95% Rat
Age (IHD Confidence (IHD Confidence without Confidence without Confidence ratio Confidence rati
group subset) Interval subset) Interval AMI Interval AMI Interval (men) Interval (wo
45-54 11.9 10.9-13.0 19.0 per 16.6-21.7 2.6 per 2.5-2.6 1.8 per 1.7-1.8 4.6 4.3-5.1 1
per 1,000 1,000 1,000
people
55-64 20.0 19.2-20.9 30.7 per 28.7-32.9 6.3 per 6.2-6.4 4.1 per 4.0-4.2 3.2 3.0-3.3
per 1,000 1,000 1,000
people
65-74 41.3 40.1-42.5 52.2 per 50.0-54.4 14.3 per 14.1-14.5 9.8 per 9.6-9.9 2.9 2.8-3.0
per 1,000 1,000 1,000
people
75-84 93.6 91.6-95.7 96.2 per 93.5-98.9 39.2 per 38.7-39.7 27.4 per 27.1-27.8 2.4 2.3-2.4
per 1,000 1,000 1,000
people
85+ 200.6 196.2-205.0 197.6 193.7-201.5 107.7 106.4-109.0 93.9 per 93.1-94.8 1.9 1.8-1.9
per per per 1,000
1,000 1,000 1,000 people
Figure 10C. All-cause mortality rates within 365 days of a hospital admission with a recorded history of acute myocardial
infarction (AMI), among Canadians aged 20 years and older, by age group and sex, Canada *, 2011–2012
Figure 10C. Text description follows.
Figure 10C: All-cause mortality rates within 365 days of a hospital admission with a recorded history
of acute myocardial infarction (AMI), among Canadians aged 20 years and older, by age group and
sex, Canada *, 2011–2012.
Age 95% Confidence 95% Confidence 95% Confidence
group Men Interval Women Interval Total Interval
20-44 20.9 per 1,000 15.0-28.5 60.0 per 1,000 40.5-85.7 24.9 per 1,000 19.0-32.0
people people a people
45-54 45.8 per 1,000 40.8-51.3 67.0 per 1,000 55.6-80.2 50.3 per 1,000 45.6-55.3
55-64 80.7 per 1,000 75.5-86.2 133.5 per 1,000 122.2-145.6 93.6 per 1,000 88.8-98.7

Age 95% Confidence 95% Confidence 95% Confidence
group Men Interval Women Interval Total Interval
65-74 175.0 per 1,000 167.3-183.0 194.7 per 1,000 183.4-206.5 182.1 per 1,000 175.7-188.7
75-84 328.9 per 1,000 318.1-340.0 319.3 per 1,000 307.1-331.9 325.0 per 1,000 316.8-333.2
85+ 522.0 per 1,000 504.1-540.4 470.9 per 1,000 456.5-485.7 492.5 per 1,000 481.3-504.0
Figure 10D. All-cause mortality rates and rate ratios among Canadians aged 40 years and older with diagnosed heart
failure compared to those without, by age group and sex, Canada *, 2012–2013
Figure 10D. Text description follows.
Figure 10D: All-cause mortality rates and rate ratios among Canadians aged 40 years and older with diagn
failure compared to those without, by age group and sex, Canada *, 2012–2013.
Men Women Men Women
with 95% with 95% without 95% without 95% Rate 95% Rate
Age heart Confidence heart Confidence heart Confidence heart Confidence ratio Confidence ratio
group failure Interval failure Interval failure Interval failure Interval (men) Interval (wom
40-54 34.3 31.9-36.9 38.4 per 35.2-41.9 2.1 per 2.0-2.1 1.4 per 1.4-1.4 27.3 24.9-29.8 16
per 1,000 1,000 1,000
people
55-64 47.8 46.0-49.7 47.5 per 45.2-49.9 5.9 per 5.8-6.0 3.8 per 3.7-3.9 12.4 11.8-13.1 8
per 1,000 1,000 1,000
people
65-74 74.0 72.2-75.8 68.4 per 66.3-70.5 12.8 per 12.6-13.0 8.6 per 8.4-8.7 8.0 7.7-8.3 5
per 1,000 1,000 1,000
people
75-84 126.6 124.5-128.8 104.8 102.8-106.8 32.7 per 32.3-33.2 23.1 per 22.7-23.4 4.5 4.4-4.7 3
per per 1,000 1,000
people people
85+ 223.8 220.4-227.4 197.6 195.1-200.1 85.4 per 84.2-86.7 75.5 per 74.7-76.3 2.6 2.6-2.7 2
per per 1,000 1,000
people people
Factors contributing to the sex differences in heart disease

As shown in Figure 8A, women have incident heart disease about ten years later than men. Such a lag has been
documented in the Framingham Heart Study. 23, 24 Evidence indicates that sex hormones, namely estrogens, provide a
cardioprotective effect to women before menopause 25, 26, 27, 28 which may explain the lower incidence rates observed in
younger women compared to men or postmenopausal women of the same age. This protective effect disappears shortly
after menopause, 24 at which time drop in sex hormones occurs and the risk of coronary heart disease rises sharply.
The mechanism explaining this protective effect has yet to be fully understood. The burden of risk factors that women carry
after menopause, such as a rise in cholesterol levels and a high prevalence of hypertension and diabetes, has been shown
to make women more vulnerable to heart disease. 24
Moreover, heart conditions may be more difficult to diagnose in women because they sometimes have fewer typical
symptoms compared with men, which may contribute to the sex-specific gap. Although chest pain is the most common
symptom of AMI in both sexes, women are more likely than men to present to the hospital without chest pain or with mild
chest pain. As a result, women are more likely to be misdiagnosed. 29, 30 Longer delays in seeking medical care have also
been documented in women and may contribute to poorer outcomes for women than men, such as higher in-hospital
mortality. 29 Complications such as major bleeding during hospitalization have also been studied and women, especially
younger women, were at greater risk than men of having such complications. 31
These factors likely also contribute to the higher all-cause mortality rates observed in women younger than 75 years old
compared with men of the same age who had a prior AMI, as shown in Figure 10B and Figure 10C above. Studies have
found similar results, with younger women having higher mortality than men after a myocardial infarction. 32, 33, 34 Even
after adjusting for comorbidities and cardiovascular risk factors, Champney et al. found that women aged less than 70
years old still had a greater risk of death (approximately 20%) compared to men in the same age group. 33
In the CCDSS, this difference in all-cause mortality among women and men with IHD (or those who had an AMI)
disappeared after the age of 75 years. In fact, elderly men have higher all-cause mortality rates than women of the same
age. Women's longer life expectancy 35 and greater use of health services in general in older age, including visiting a
general practitioner, may contribute to the pattern observed. 36
With men being more likely than women to be newly diagnosed with IHD and heart failure, it is important to continue to
raise awareness of the heart disease burden in men. Better detection of heart disease in women of all ages is also of high
importance because of the high fatality rate associated with their first AMI 21 and poorer outcomes and risk of
complications in general.
Text Description
Heart disease differences between men and women. Heart disease is more common among men than among women,
with men being as much as two and a half times more likely than women to have had a heart attack. In a given year,
young men (aged 20 to 39) with IHD are 11 times more likely to die of any cause than young men without IHD. In a
given year, men between the ages of 40 and 54 with heart failure are 16 times more likely to die of any cause than
men of the same age without heart failure.
On average, women develop heart disease about 10 years later than men. In a given year, young women (aged 20 to
39) with IHD are 18 times more likely to die of any cause than young women without IHD. In a given year, women
between the ages of 40 and 54 with heart failure are 27 times more likely to die of any cause than women of the same
age without heart failure.
2.3 Pan-Canadian perspective

Across Canada, estimates vary widely by province/territory and by condition. Unless otherwise specified, all differences
from the national average presented herein are statistically significant.
2.3.1 Prevalence
In 2012–2013, age-standardized ischemic heart disease (IHD) prevalence ranged from a low of 4.6% in Nunavut to a
high of 9.7% in Nova Scotia (Figure 11).
Age-standardized acute myocardial infarction (AMI) occurrence ranged from a low of 1.1% in Nunavut to a high of 2.6%
in Newfoundland and Labrador (Figure 12).
Age-standardized heart failure prevalence ranged from a low of 3.2% in Quebec, New Brunswick and Nova Scotia to a
high of 6.4% in Nunavut (Figure 13).
Figure 11. Age-standardized † prevalence of diagnosed ischemic heart disease, among Canadians aged 20 years and older,
by province or territory *, 2012–2013

Figure 11. Text description follows.
Figure 11. Age-standardized † prevalence of diagnosed ischemic heart disease, among Canadians
aged 20 years and older, by province or territory *, 2012–2013.
Province or territory * Prevalence (%) 95% Confidence Interval
Canada 8.1% 8.1-8.1
Yukon N/A N/A

Northwest Territories 6.8% 6.5-7.3
Nunavut 4.6% 4.1-5.2
British Columbia 6.6% 6.6-6.6

Alberta 7.3% 7.3-7.3
Saskatchewan 7.8% 7.8-7.9

Manitoba 6.6% 6.6-6.7
Ontario 8.5% 8.5-8.5
Quebec 8.4% 8.4-8.5

New Brunswick 9.4% 9.3-9.4
Nova Scotia 9.7% 9.7-9.8
Prince Edward Island 6.9% 6.8-7.0

Newfoundland and Labrador 8.0% 8.0-8.1
Figure 12. Age-standardized † occurrence of acute myocardial infarction, among Canadians aged 20 years and older, by
province or territory *, 2012–2013
Figure 12. Age-standardized † occurrence of acute myocardial infarction, among Canadians aged 20
years and older, by province or territory *, 2012–2013.
Province or territory * Occurrence (%) 95% Confidence Interval
Canada 2.0% 2.0-2.0
Yukon N/A N/A

Nunavut 1.1% 0.9-1.4

Alberta 1.8% 1.8-1.9
Manitoba 2.1% 2.1-2.1

Ontario 1.9% 1.9-1.9
Quebec 2.1% 2.1-2.1

Province or territory * Occurrence (%) 95% Confidence Interval


Figure 13. Age-standardized † prevalence of diagnosed heart failure, among Canadians aged 40 years and older, by
province or territory *, 2012–2013
Figure 13. Age-standardized † prevalence of diagnosed heart failure, among Canadians aged 40 years
and older, by province or territory *, 2012–2013.
Canada 3.4% 3.4-3.4
Yukon N/A N/A

Nunavut 6.4% 5.6-7.3

Alberta 3.8% 3.7-3.8

Manitoba 3.8% 3.8-3.9
Ontario 3.3% 3.3-3.3
Quebec 3.2% 3.2-3.2



In 2012–2013, age-standardized IHD incidence rates ranged from a low of 4.5 per 1,000 in Nunavut to a high of 8.2 per
1,000 in New Brunswick (Figure 14). Rates in New Brunswick, Quebec and Alberta were higher than the national
average.
As for AMI, age-standardized rates ranged from 1.9 per 1,000 in British Columbia to 2.9 per 1,000 in Nova Scotia (Figure
14).
Age-standardized heart failure incidence rates ranged from 4.8 per 1,000 in Nova Scotia and Newfoundland and
Labrador to 11.3 per 1,000 in Nunavut, but the latter should be interpreted with caution due to variability in the rates.
Heart failure incidence rates were higher in British Columbia, Alberta, Saskatchewan and Manitoba while rates in
Ontario, Quebec and Nova Scotia were lower than the Canadian average (Figure 15). Rates in the other provinces and
territories were not statistically different than Canada as a whole.
Figure 14. Incidence (rate †) of diagnosed ischemic heart disease and occurrence (rate †) of first acute myocardial infarction
(AMI), among Canadians aged 20 years and older, by province or territory *, 2012–2013
Notes: The 95% confidence interval shows an estimated range of values which is likely to include the true value 19 times out of 20. BC: British
Columbia, AB: Alberta, SK: Saskatchewan, MB: Manitoba, ON: Ontario, QC: Quebec, NB: New Brunswick, NS: Nova Scotia, PE: Prince Edward
Island, NL: Newfoundland and Labrador, NT: Northwest Territories, NU: Nunavut.
Figure 14. Incidence (rate †) of diagnosed ischemic heart disease and occurrence (rate †) of first acute
myocardial infarction (AMI), among Canadians aged 20 years and older, by province or territory *,
2012–2013.
Province or territory IHD incidence 95% Confidence Occurrence rate first AMI (IHD 95% Confidence
*
rate Interval subset) Interval
Province or territory IHD incidence 95% Confidence Occurrence rate first AMI (IHD 95% Confidence
*
rate Interval subset) Interval
Canada 6.8 per 1,000 6.7-6.8 2.2 per 1,000 people 2.2-2.3
people
British Columbia 6.2 per 1,000 6.1-6.3 1.9 per 1,000 people 1.9-2.0
people
Alberta 7.2 per 1,000 7.1-7.3 2.2 per 1,000 people 2.1-2.3
people
Saskatchewan 6.8 per 1,000 6.6-7.0 2.2 per 1,000 people 2.1-2.3
people
Manitoba 6.5 per 1,000 6.3-6.6 2.4 per 1,000 people 2.3-2.5
people
Ontario 6.5 per 1,000 6.4-6.6 2.1 per 1,000 people 2.0-2.1
people
Quebec 7.4 per 1,000 7.3-7.5 2.6 per 1,000 people 2.5-2.6
people
New Brunswick 8.2 per 1,000 7.9-8.4 2.8 per 1,000 people 2.7-3.0
people
Nova Scotia 6.8 per 1,000 6.7-7.0 2.9 per 1,000 people 2.8-3.0
people
Prince Edward Island 5.8 per 1,000 5.4-6.3 2.5 per 1,000 people 2.3-2.8
people
Newfoundland and 5.7 per 1,000 5.5-6.0 2.6 per 1,000 people 2.4-2.7
Labrador people
Northwest Territories 7.1 per 1,000 5.8-8.7 2.7 per 1,000 people 1.9-3.7
people
Nunavut 4.5 per 1,000 3.3-7.0 2.2 per 1,000 people a 1.3-4.1
people
Figure 15. Age-standardized † incidence of diagnosed heart failure, among Canadians aged 40 years and older, by province
or territory *, 2012–2013
Notes: The 95% confidence interval shows an estimated range of values which is likely to include the true value 19 times out of 20. BC: British
Columbia, AB: Alberta, SK: Saskatchewan, MB: Manitoba, ON: Ontario, QC: Quebec, NB: New Brunswick, NS: Nova Scotia, PE: Prince Edward
Island, NL: Newfoundland and Labrador, NT: Northwest Territories, NU: Nunavut.
Figure 15. Age-standardized † incidence of diagnosed heart failure, among Canadians aged 40 years
and older, by province or territory *, 2012–2013.
Province or territory * Incidence rate 95% Confidence Interval
Canada 5.3 per 1,000 people 5.2-5.3

British Columbia 5.9 per 1,000 people 5.8-6.0
Alberta 6.1 per 1,000 people 5.9-6.2

Saskatchewan 5.9 per 1,000 people 5.7-6.1
Manitoba 6.5 per 1,000 people 6.3-6.7
Province or territory * Incidence rate 95% Confidence Interval
Ontario 4.9 per 1,000 people 4.9-5.0
Quebec 5.0 per 1,000 people 4.9-5.0

New Brunswick 5.2 per 1,000 people 5.0-5.5
Nova Scotia 4.8 per 1,000 people 4.7-5.0

Prince Edward Island 5.6 per 1,000 people 5.1-6.1
Newfoundland and Labrador 4.8 per 1,000 people 4.6-5.1
Northwest Territories 6.0 per 1,000 people 4.4-8.1

Nunavut 11.3 per 1,000 people a 7.8-17.0
The differences observed for IHD and AMI across provinces and territories may relate to differences in the distribution of
risk factors known to contribute to the development of heart disease such as smoking, low level of physical activity, alcohol
abuse, low consumption of fruits and vegetables, obesity, diabetes and hypertension. These risk factors have been
documented to be high in the Atlantic provinces. 6 However, differences in detection and treatment practices, as well as
differences in data coding, remuneration models and shadow billing practices also likely play a role in the patterns
observed. Even though differences are statistically significant, methodological differences may explain the patterns
observed in addition to actual differences in the health status of the populations.
Heart failure estimates were higher in British Columbia, Alberta, Saskatchewan and Manitoba and lower in Quebec, New
Brunswick and Nova Scotia, a pattern that is not consistent with that observed for IHD and AMI. This may relate to
differences in billing methods and clinical practices as highlighted previously and warrants further investigation.
3. Ischemic heart disease and heart failure relationship

3.1 Heart disease risk factors and treatments
The underlying mechanism of ischemic heart disease (IHD) is atherosclerosis, which refers to the build-up of plaque (fat
and other materials) on the inner walls of coronary arteries. Atherosclerosis can lead to blockages of the coronary arteries
and restrict the flow of blood to the heart muscle.
Risk factors for IHD include high cholesterol, smoking, high blood pressure (hypertension), diabetes, abdominal obesity,
and lack of regular physical activity. 17 Unhealthy diet and excessive alcohol consumption have also been shown to increase
the risk of IHD. 17 Treatment options for IHD include lifestyle management, medications, and procedures such as
percutaneous coronary intervention or coronary artery bypass graft surgery.
IHD can lead to acute myocardial infarction (AMI) which refers to deprivation of blood supply to a part of the heart muscle
for a long enough period of time to cause tissue death. The most common reason for an AMI is thrombus formation (blood
clot) in vessels with plaque. Typical symptoms of an AMI may include chest pain, often radiating to the left arm and left side
of the neck, shortness of breath, sweating, and palpitations.
Left untreated, IHD may lead to heart failure over time. Heart failure is a clinical syndrome and refers to the inability of the
heart to pump an adequate volume of blood throughout the body. In other words, the heart is not pumping as well as it
should. The most common cause of heart failure is damage to the heart muscle as a result of heart disease. 37 Other factors
may also increase the risk of heart failure including, but not limited to, higher body mass index, abdominal fat
accumulation, elevated blood cholesterol, elevated fasting blood glucose, elevated systolic blood pressure, cigarette
smoking, and valvular heart disease. 37, 38 Symptoms of heart failure may include shortness of breath, swelling of the legs,
and a low energy level. 38 The management of heart failure includes medications, restriction of fluid intake, and a low salt
diet. 38
3.2 Ischemic heart disease and heart failure comorbidity

Examining the comorbidity of IHD and heart failure in the Canadian Chronic Disease Surveillance System in 2012–2013
overall, it was found that among those with diagnosed heart failure, about 71.0% of individuals aged 40 years and older
also had IHD compared to only about 10.5% in those without heart failure. The age-specific prevalence of IHD among those
with and without heart failure is shown in Figure 16. The prevalence of IHD among those with and without heart failure
increased with age, but the difference between the two groups declined with age.
Over time, the age-standardized prevalence ratio of IHD among those with and without heart failure decreased from 6.9 in
2000–2001 to 5.7 in 2012–2013 (Figure 17). A similar decline is seen for both women and men. This trend suggests that the
difference in IHD prevalence between those with and without heart failure is getting smaller over time.
Overall, in 2012–2013, among those aged 40 years and older with diagnosed IHD, about 20.3% also had heart failure
compared to only 1.2% in those aged 40 years and older without IHD. The age-specific prevalence of heart failure among
those with and without IHD is shown in Figure 18. The prevalence of heart failure among those with and without IHD
increased with age and the difference between the two groups declined with age.
The age-standardized prevalence ratio of heart failure among those with and without IHD decreased over time from 9.3 in
2000–2001 to 8.8 in 2012–2013. The prevalence ratio remained constant in men over the observation period, but declined
from 9.2 to 8.2 in women (Figure 19).
Text Description
IHD and heart failure comorbidity. 71% of Canadians aged 40 years and older with heart failure also have IHD while
20% of Canadians aged 40 years and older with IHD have heart failure.
Figure 16. Prevalence of diagnosed ischemic heart disease (IHD) among Canadians aged 40 years and older with and
without diagnosed heart failure (HF), by age group, Canada *, 2012–2013
Figure 16. Prevalence of diagnosed ischemic heart disease (IHD) among Canadians aged 40 years and
older with and without diagnosed heart failure (HF), by age group, Canada *, 2012–2013
Age group (Years) IHD with HF 95% Confidence Interval IHD without HF 95% Confidence Interval
40-44 43.6% 41.5-45.8 1.5% 1.4-1.5
45-49 49.3% 47.9-50.6 2.7% 2.7-2.7
50-54 57.1% 56.1-58.1 4.7% 4.6-4.7

55-59 63.1% 62.3- 64.0 7.6% 7.6-7.6
60-64 68.1% 67.4- 68.9 11.6% 11.5-11.6

Age group (Years) IHD with HF 95% Confidence Interval IHD without HF 95% Confidence Interval
65-69 71.6% 70.9-72.2 16.5% 16.4-16.5

70-74 73.8% 73.2-74.4 21.7% 21.6-21.8
75-79 74.7% 74.2-75.3 26.7% 26.6-26.8

80-84 74.6% 74.1-75.1 31.0% 30.8-31.1
85+ 71.2% 70.8-71.6 32.9% 32.7-33.0

Figure 17. Age-standardized † prevalence ratio of diagnosed ischemic heart disease among Canadians aged 40 years and
older with and without diagnosed heart failure, Canada *, 2000–2001 to 2012–2013
Figure 17. Age-standardized † prevalence ratio of diagnosed ischemic heart disease among Canadians
aged 40 years and older with and without diagnosed heart failure, Canada *, 2000–2001 to 2012–2013
Fiscal Year Men 95% Confidence Interval Women 95% Confidence Interval Total 95% Confidence Interval
2000-2001 6.0 6.0-6.1 7.7 7.6-7.8 6.9 6.9-7.0

2001-2002 5.9 5.8-5.9 7.4 7.3-7.5 6.7 6.6-6.8
2002-2003 5.7 5.6-5.7 7.1 7.0-7.2 6.5 6.4-6.5
2003-2004 5.6 5.5-5.6 7.0 6.9-7.1 6.4 6.3-6.4

2004-2005 5.5 5.4-5.5 6.8 6.7-6.9 6.2 6.2-6.3
2005-2006 5.4 5.3-5.4 6.7 6.6-6.8 6.1 6.1-6.1
2006-2007 5.2 5.2-5.3 6.6 6.5-6.6 6.0 5.9-6.0

2007-2008 5.2 5.1-5.2 6.4 6.3-6.5 5.9 5.8-5.9
2008-2009 5.1 5.0-5.1 6.3 6.2-6.4 5.8 5.7-5.8

2009-2010 5.0 5.0-5.1 6.3 6.2-6.4 5.7 5.7-5.8
2010-2011 5.0 5.0-5.0 6.2 6.2-6.3 5.7 5.7-5.7
2011-2012 5.0 5.0-5.0 6.2 6.1-6.3 5.7 5.6-5.7

2012-2013 5.0 5.0-5.1 6.2 6.2-6.3 5.7 5.7-5.7
Figure 18. Prevalence of diagnosed heart failure (HF) among Canadians aged 40 years and older with and without
diagnosed ischemic heart disease (IHD), by age group, Canada *, 2012–2013
Figure 18. Prevalence of diagnosed heart failure (HF) among Canadians aged 40 years and older with
and without diagnosed ischemic heart disease (IHD), by age group, Canada *, 2012–2013
Age group (Years) IDH without HF 95% Confidence Interval IDH with HF 95% Confidence Interval
40-44 0.1% 0.1-0.1 4.2% 4.0-4.4

45-49 0.2% 0.2-0.2 6.6% 6.4-6.8
50-54 0.3% 0.3-0.3 8.4% 8.2-8.5

Age group (Years) IDH without HF 95% Confidence Interval IDH with HF 95% Confidence Interval
55-59 0.6% 0.5-0.6 10.3% 10.2-10.5
60-64 0.9% 0.9-0.9 12.6% 12.5-12.7

65-69 1.4% 1.3-1.4 15.0% 14.9-15.2
70-74 2.2% 2.1-2.2 18.4% 18.3-18.6
75-79 3.5% 3.5-3.6 22.9% 22.7-23.0

80-84 5.9% 5.8-6.0 29.1% 28.9-29.3
85+ 11.4% 11.3-11.5 39.3% 39.1-39.5

Figure 19. Age-standardized † prevalence ratio of diagnosed heart failure among Canadians aged 40 years and older with
and without diagnosed ischemic heart disease (IHD), Canada *, 2000–2001 to 2012–2013

Figure 19. Age-standardized † prevalence ratio of diagnosed heart failure among Canadians aged 40
years and older with and without diagnosed ischemic heart disease (IHD), Canada *, 2000–2001 to
2012–2013.
Fiscal Year Men 95% Confidence Interval Women 95% Confidence Interval Total 95% Confidence Interval
2000-2001 9.1 9.0-9.2 9.2 9.1-9.3 9.3 9.2-9.3
2001-2002 9.3 9.2-9.4 9.1 9.0-9.2 9.3 9.2-9.4

2002-2003 9.3 9.2-9.4 9.0 8.9-9.1 9.3 9.2-9.4
2003-2004 9.4 9.3-9.5 8.9 8.8-9.0 9.3 9.2-9.3

2004-2005 9.4 9.3-9.5 8.8 8.8-8.9 9.2 9.2-9.3
2005-2006 9.4 9.3-9.5 8.8 8.7-8.9 9.2 9.1-9.3
2006-2007 9.3 9.2-9.4 8.7 8.6-8.8 9.1 9.1-9.2

2007-2008 9.3 9.2-9.4 8.6 8.5-8.7 9.1 9.0-9.1
2008-2009 9.2 9.1-9.3 8.5 8.4-8.6 9.0 8.9-9.0
2009-2010 9.1 9.0-9.2 8.4 8.3-8.5 8.9 8.8-9.0

2010-2011 9.1 9.0-9.2 8.3 8.3-8.4 8.9 8.8-8.9
2011-2012 9.1 9.0-9.2 8.3 8.2-8.3 8.8 8.8-8.9

2012-2013 9.1 9.0-9.2 8.2 8.2-8.3 8.8 8.8-8.9
Closing Remarks
The findings included in this report provide an overview of heart disease profiles and trends in Canada. Advancements in
the prevention and management of heart disease are reflected by the declining incidence and all-cause mortality rates
between 2000–2001 and 2012–2013. Heart disease death rates have declined rapidly over the last few decades. In fact, heart
disease, which used to be the leading cause of death in Canada, has now become the second cause of death after cancer,
starting in 2007. 39
Specifically, this report indicates that Canadians with ischemic heart disease (IHD) and heart failure are surviving longer, as
shown by the relatively steady prevalence and decreasing incidence and all-cause mortality rates over time. Nonetheless,
the burden is substantial, with about 2.4 million Canadian adults living with IHD in 2012–2013, including 578,000 Canadians
who had an acute myocardial infarction (AMI), and about 670,000 living with heart failure. The absolute number of
Canadians living with these conditions is increasing over time, likely due to the aging of the population, population growth
as well as improved survival of those affected. Men are more likely than women to have IHD and heart failure or to have an
AMI. However, among those who had an AMI, women younger than 75 years old are more likely to die of any cause than
men of the same age in a given year. In addition, the vast majority (71%) of Canadians aged 40 years and older with heart
failure also have IHD. Since IHD is the main risk factor for heart failure, prevention of IHD would likely reduce incident heart
failure.
Heart disease can be prevented by targeting lifestyle risk factors, such as, smoking, physical inactivity, poor diet, alcohol
abuse and risk conditions, namely high cholesterol, obesity, diabetes, and hypertension. The ongoing monitoring of these
risk factors and conditions is important in order to inform the development of public health interventions aiming to prevent
heart disease and improve disease management.
Online Resources
Interactive Data Tools
Heart Disease Information
Appendix A
Canadian Chronic Disease Surveillance System
The Canadian Chronic Disease Surveillance System (CCDSS) is a collaborative network of provincial and territorial chronic
disease surveillance systems, led by the Public Health Agency of Canada (PHAC). Its aim is to foster the collection of
surveillance data in a consistent and comparable way across all provinces and territories. PHAC uses data from the system
to describe epidemiological trends and profiles of chronic diseases and conditions in Canada. The CCDSS has expanded
from its initial mandate of diabetes surveillance to include data on several additional chronic diseases and conditions
including: hypertension, mental illness, mood and anxiety disorders, asthma, chronic obstructive pulmonary disease, heart
failure, ischemic heart disease, acute myocardial infarction, stroke, arthritis, osteoporosis, and some neurological
conditions. It is guided by the expertise of the CCDSS Science Committee, with representatives from each province and
territory.
The CCDSS identifies chronic disease cases from provincial and territorial administrative health databases, including
physician billing claims and hospital discharge abstract records, linked to provincial and territorial health insurance
registry records using a unique personal identifier. Data on all residents eligible for provincial or territorial health
insurance (about 97% of the Canadian population) are captured in the health insurance registries; thus, the CCDSS
coverage is near-universal. Not included in the CCDSS are Canadians covered under federal health programs such as
refugee protection claimants, full-time members of the Canadian Forces, eligible veterans, individuals in the Royal
Canadian Mounted Police, and federal penitentiary inmates.
Appendix B
Heart disease case definitions
This report features data on insured individuals 'diagnosed' with ischemic heart disease (IHD), including those who had an
acute myocardial infarction (AMI), or heart failure. 'Diagnosed' refers to people who have met one of the case definitions
defined in Table 1 below.
The disease case definitions were developed based on a review of the literature, validation studies, 40, 41 feasibility studies,
42 43
, national pilot study results, and recommendations from the Canadian Chronic Disease Surveillance System (CCDSS)
Heart Disease Working Group. Hospital discharge abstract records and physician billing claims were used for case
ascertainment of IHD and heart failure. Case ascertainment of AMI was based on hospital discharge abstract records only.
The recommended case criteria were applied for those who were 20 years of age or older for IHD and AMI, and 40 years of
age or older for heart failure. The case date of identification for IHD and heart failure was the date of inpatient hospital
separation or the last physician visit, whichever came first. The case date of AMI identification was the date of the hospital
admission. The denominator for the rate and proportion calculations in the report was the number of individuals in the
provincial and territorial health insurance registries. Individual demographic information (i.e. age, sex, province or territory
of residence and date of death, if applicable) is obtained from these registries; age is calculated as of the end of the fiscal
year, on March 31.
Table 1. Case definitions of ischemic heart disease (IHD), acute myocardial infarction (AMI), and heart
failure (HF)
Condition
(Age) Case Definition ICD * Codes
IHD (20+) At least one hospital separation listing a diagnostic or procedure code for IHD in ICD-9/ICD-9-CM †: 410-414
any diagnostic field 36.01, 36.02, 36.05, 36.10-
OR 36.19
At least two physician billing claims listing a diagnostic code for IHD in any
ICD-10-CA ‡: I20-I25
diagnostic field in a one-year period
CCP ‡‡: 48.02, 48.03, 48.11-
48.19
CCI §: 1.IJ.50, 1.IJ.57.GQ,
1.IJ.54, 1.IJ.76
AMI (20+) At least one hospital admission listing a diagnostic code of AMI in diagnostic ICD-9/ICD-9-CM: 410
types M, W, X, Y, 1, or 2 §§
ICD-10-CA: I21-I22
HF (40+) At least one hospital separation listing a diagnostic code of HF in any diagnostic ICD-9/ICD-9-CM: 428
field
ICD-10-CA: I50
OR
At least two physician billing claims listing a diagnostic code of HF in any
diagnostic field in a one-year period
* ICD = International Classification of Diseases
† CM = Clinical Modification
‡ CA = Canada
‡‡ CCD = Canadian Classification of Diagnostic, Therapeutic and Surgical Procedures
§ CCI = Canadian Classification of Health Interventions
§§ Type M = The one diagnosis or condition that can be described as being most responsible for the patient's stay in hospital; types
W, X, Y = service transfer diagnosis type (W), (X), (Y) code associated with the first/second/third service transfer; Type 1 = condition
that existed prior to admission, has been assigned an ICD-10-CA code, and satisfies the requirements for determining comorbidity;
Type 2 = condition that arises post-admission, has been assigned an ICD-10-CA code and satisfies the requirements for
determining comorbidity. 44 Quebec submits all diagnostic types instead of M,W,X,Y,1,2.
Appendix C
Methods
All provinces and territories started identifying cases in their databases as of 1995–1996; with the exception of Quebec
which began in 1996–1997 and Nunavut which began in 2005–2006. Data from Yukon were not available for this report.
Estimates in this report refer to data from fiscal years 2000–2001 to 2012–2013. For the 365-day all-cause AMI mortality
indicator, the latest year of data (i.e. 2012–2013) is not included to ensure that individuals who had an AMI have an equal
opportunity to be followed up for a full 365-day period.
Given that historical information was not available prior to fiscal year 1995–1996, the first hospitalization with an AMI
diagnostic code during the 2000–2001 fiscal year was considered the start of the index episode. Patients who had been
hospitalized for an AMI (ICD-9/ICD-9-CM: 410 or ICD-10-CA: I21-I22) in the five years before their admission in 2000–2001
were excluded to avoid classifying previously prevalent cases as incident cases. Occurrence rate of first AMI was
approximated by first-time AMI hospitalization. This indicator took into account whether someone had a prior history of
hospitalized AMI and only included those who were experiencing their first-time hospitalized AMI during the surveillance
period.
The 2011 Canadian standard population was used for age standardization and 95% confidence intervals were computed
using an inverse gamma distribution. Where indicated, data with a coefficient of variation between 16.6% and 33.3% should
be interpreted with caution. Data with a coefficient of variation greater than 33.3% or cells with less than 10 counts are not
reported.
In order to determine whether differences between each respective province/territory estimates and the pan-Canadian
estimate were statistically significant, a Z-test was conducted. P-values less than 0.001 were considered statistically
significant.
Random rounding was applied to eliminate the possibility of residual disclosure when reporting data with small cell sizes. 45
Random rounding was applied to all counts presented in the text, tables and figures. For Ontario and Canada, the counts
were rounded to the nearest 10. For all the other provinces and territories, the counts were rounded to the nearest 5.
Crude estimates were calculated after random rounding while age-standardized estimates were calculated using non-
rounded counts. Numbers presented in the text of the report were rounded to the nearest hundred thousand or the
nearest hundred, where relevant.
Appendix D
Limitations
The main limitations of the Canadian Chronic Disease Surveillance System (CCDSS) are described below.
First, findings within this report likely underestimate the true burden of heart disease in Canada. Data on other heart
conditions such as atrial fibrillation and peripheral vascular disease are not included in the CCDSS.
Second, only data of people who have sought care are included in the CCDSS. Therefore, people who do not seek medical
care are not captured; for example, those who are undiagnosed, those who are diagnosed prior to the observation period
but do not require regular care because their condition is well managed, or those who die of a heart attack prior to being
admitted to the hospital and receiving a diagnosis. More cases could be identified through investigating cause of death in
vital statistics, but this data source was not available in all provinces and territories. Sensitivity analyses conducted in Nova
Scotia and Quebec found that capturing fatal acute myocardial infarction (AMI) events using vital statistics would increase
rates of first-time AMI by 16% in Nova Scotia (unpublished results) and 22% in Quebec. 46 Thus, trends presented in this
report might underestimate the true occurrence of AMI in Canada.
Third, the CCDSS may underestimate the burden of heart disease as it relies partly on the physician billing claims database
to identify cases. One of the limitations of this database is that physicians not paid on a fee-for-service basis are not always
required to submit medical claims. Other payment schemes include salary, contract, capitation and partial fee-for-service.
Alternative payment of physicians is more frequent for some specialties, in remote areas and for some primary health care
centres. However, in some jurisdictions, physicians under alternative payment schemes are still expected to remit service
information, otherwise known as "shadow billing". Both fee-for-service claims and shadow billing were included where
available. Services for non-fee-for-service physicians who do not shadow bill are not captured. Currently, it is not possible
to establish the magnitude of this impact at the national scale; further studies are required.
Fourth, as with any surveillance system, there is the potential for false positives (wrongly identifying someone as having
the disease when the person does not) and false negatives (wrongly identifying someone as not having the disease when
the person does). However, the case definitions used to identify heart disease cases were validated and selected in order to
minimize the number of false positives and false negatives.
Finally, some individuals have a valid health insurance number in more than one province or territory during a year
because of immigration or emigration and they are included in each of the provincial or territorial insured population.
Glossary
Acute myocardial infarction (AMI):
A manifestation of ischemic heart disease, AMI refers to a reduction or sudden loss of blood supply to a part of the heart
muscle leading to tissue death.
Age-standardized rate or proportion:

A rate or proportion adjusted for the differences in population age structure between the study population and a reference
population. Age-standardized rates or proportions are commonly used in trend analysis or when comparing rates for
different geographic areas or different subgroups.
All-cause mortality:
Mortality due to any cause of death occurring during a given period of time.
Angina pectoris:
A symptomatic manifestation of ischemic heart disease, describing a severe squeezing or pressure-like thoracic pain,
brought on by exertion or stress, usually lasting less than 30 minutes at a time. An increase in frequency or occurrence at
rest especially at night is called unstable angina and may indicate an increased risk of a heart attack. It is often referred to
simply as angina.
Average annual percent change (AAPC):

The average annual percent change over several years is used to measure the change in proportions or rates over time.
The calculation involves fitting a straight line to the natural logarithm of the data when it is displayed by calendar or fiscal
year. The slope of the line, expressed in percentages, represents the annual percent change.
365-day all-cause mortality:

Mortality due to any cause of death, within 365 days of a hospitalization listing a diagnostic code of acute myocardial
infarction.
Cardiac arrhythmia:
A loss of rhythm of the heart beat which becomes irregular.
Comorbidity:
Coexisting diseases or conditions which are additional to a specific disease or condition under study.
Confidence intervals (CI):

A statistical measurement of the reliability of an estimate. The size of the confidence interval relates to the precision of the
estimate with narrow confidence intervals indicating greater reliability than those that are wide. The 95% confidence
interval shows an estimated range of values which is likely to include the true value 19 times out of 20.
Disability-adjusted life year (DALY):

A measure of overall disease burden, expressed as the number of years lost due to ill-health, disability or early death. It can
be used to compare the overall health and life expectancy in different countries.
Fee-for-service:
Payment of claims based on submission of individual medical services.
Heart failure:
A chronic condition occurring when the pumping action of the heart cannot provide enough blood to the rest of the body
as it is needed. This can happen as a result of damage to the heart muscle, for example from a heart attack, or from
excessive consumption of alcohol, or because of a heart muscle disease which is also called a cardiomyopathy.
Hospital separation:
A hospital separation is the departure of an inpatient from hospital, either due to a discharge or death. Hospital separation
records are completed by hospitals for each patient who is discharged or who dies in hospital. Hospital separation records
provide data on the relative frequency of a disease and the trends in morbidity from it. 47
Incidence:
The number of new cases of a disease or condition occurring in a given time period in a population at risk, expressed as a
proportion or rate.
Insured population:
The total number of individuals who had a valid health insurance number within a selected province or territory at any
point during the selected year. Individuals who had less than a full year of coverage, due to immigration, emigration, birth,
or death during that year are included in the population.
International Classification of Diseases (ICD) code:

An international standard diagnostic classification for diseases and other health conditions for epidemiological, clinical and
health management purposes. For example, it is used to monitor the incidence and prevalence of diseases and other
health problems, proving a picture of the general health situation of countries and populations. 48
Ischemic heart disease (IHD):

Also referred to as coronary heart disease, a chronic condition in which the heart muscle is damaged or works inefficiently
due to the absence or relative deficiency of its blood supply.
Morbidity:
Any departure, subjective or objective, from a state of physiological or psychological wellbeing.
Non-communicable disease:
Non-communicable (or chronic) diseases are diseases of long duration and generally slow progression that are not caused
by infectious agents (are not passed from person to person).
Occurrence:
Refers to the occurrence of the disease. The occurrence measure must be understood as a proportion between two
quantities. Depending on the quantity appearing in the denominator, it is either expressed in percent or per 1,000 in this
report. It is only used in this report to refer to the occurrence of acute myocardial infarction.
Prevalence:
The frequency of a disease or condition in a population during a defined period of time expressed as the proportion of that
population that has the disease or condition. Prevalence provides a measure of the burden of the disease or condition in
the population.
Prevalence ratio:
The ratio of two prevalence measures. For example, the prevalence of a disease or condition among people with diagnosed
heart failure compared to those without diagnosed heart failure.
Rate ratio:
The ratio of two related measures. For example, the all-cause mortality rate among those with diagnosed heart failure
compared to the all-cause mortality rate among those without diagnosed heart failure.
Relative percent change:

A measure of relative change expressed as a percentage. It can be used to demonstrate how much a prevalence estimate
at the end of a surveillance period increased or decreased relative to the estimate at the beginning of a surveillance period.
Shadow billing:
An administrative process whereby salaried physicians submit service provision information using provincial and territorial
fee codes, even though they are reimbursed by other means of payment. Shadow billing can be used to maintain historical
measures of service provision based on fee-for-service claims data.
Standard population:
A population structure that is used to provide a constant age distribution, so that the rates or proportions of different study
populations can be adjusted for comparison (see age-standardized rate or proportion).
Years of life lost:

Number of years of life "lost" when a person dies "prematurely" from any cause – before age 75. A person dying at age 25,
for example, has lost 50 years of life. 49
Acknowledgements
The Public Health Agency of Canada wishes to acknowledge the following individuals for their contributions and support in
all aspects of this report from the inception and testing of the idea of using administrative data for heart disease
surveillance, through to reviewing this report.
Canadian Chronic Disease Surveillance System Heart Disease Working Group Members (Past and Present)
Camille Adams, Saskatchewan Ministry of Health
Claudia Blais, Institut national de santé publique du Québec
Jill Casey, Nova Scotia Department of Health and Wellness
Charmaine Cooke, Department of Health and Wellness
Jennifer Covey, Department of Health and Wellness
Yana Gurevich, Canadian Institute for Health Information
Janice Hawkey, Saskatchewan Ministry of Health
Karin Humphries, University of British Columbia
Helen Johansen, University of Ottawa
Douglas Lee, Institute for Clinical Evaluative Sciences
Lisa M. Lix, University of Manitoba
Janet Manuel, Canadian Institute for Health Information
Kathy Marcotte, Canadian Institute for Health Information
Pat McCrea, British Columbia Ministry of Health
Jim Nicol, Saskatchewan Ministry of Health
Céline Plante, Institut national de santé publique du Québec
Rolf Puchtinger, Saskatchewan Ministry of Health
Hude Quan, University of Calgary
Drona Rasali, British Columbia Provincial Health Services Authority
Kim Reimer, British Columbia Ministry of Health
Sue Schultz, Institute for Clinical Evaluative Sciences
Mark Smith, Manitoba Centre for Health Policy
Larry W. Svenson, University of Calgary, Alberta Ministry of Health, University of Alberta
Jack Tu, Institute for Clinical Evaluative Sciences
Karen Tu, Institute for Clinical Evaluative Sciences, University of Toronto, University Health Network
Public Health Agency of Canada Contributors (Past and Present)

Christina Bancej
Sulan Dai
Joellyn Ellison
Yong Jun Gao
Audrey Layes
Bob McRae
Louise McRae
Catherine Pelletier
Louise Pelletier
Susan Quach
Cynthia Robitaille
Kristina Sabou
Shamila Shanmugasegaram
Ming Su
Jennette Toews
Bruce Tudin
Chris Waters
Canadian Chronic Disease Surveillance System Scientific Committee

Kimberly Blinco, New Brunswick Department of Health
Charmaine Cooke, Nova Scotia Department of Health and Wellness
Shauna Demers, Yukon Health and Social Services
Valérie Émond, Institut national de santé publique du Québec
Jean-François Godin, Public Health Agency of Canada
Elsa Ho, Ontario Ministry of Health and Long-Term Care
John Knight, Newfoundland and Labrador Centre for Health Information
Shannon LeBlanc, Northwest Territories Health and Social Services
Carla Leoppky, Manitoba Health
Lisa Lix (Co-Chair), University of Manitoba
Karen MacDonald-Phillips, PEI Department of Health and Wellness
Michael Paterson, Institute for Clinical Evaluative Sciences
Rolf Puchtinger, Saskatchewan Ministry of Health
Kim Reimer (Co-Chair), British Columbia Ministry of Health
Michael A. Ruta, Government of Nunavut
Mark Smith, Manitoba Centre for Health Policy
Larry Svenson, University of Calgary, Alberta Ministry of Health, University of Alberta
Karen Tu, Institute for Clinical Evaluative Sciences, University of Toronto, University Health Network
Linda Van Til, Veterans Affairs Canada
Canadian Chronic Disease Surveillance System Technical Working Group

Joellyn Ellison, Public Health Agency of Canada
Marguerite Fenske, Yukon Health and Social Services
Maria Greif, Saskatchewan Ministry of Health
Yong Jun Gao, Public Health Agency of Canada
Shannon LeBlanc, Northwest Territories Health and Social Services
Ping Li, Institute of Clinical and Evaluative Sciences
Yue Liu, Nova Scotia Department of Health and Wellness
Karen MacDonald-Phillips, PEI Department of Health and Wellness
Bruce McDonald, Alberta Ministry of Health
Bob McRae, Public Health Agency of Canada
Mariam Osman, Alberta Ministry of Health
Mostafizur Rahman, Manitoba Health
Robin Read, Diabetes Care Program of Nova Scotia
Louis Rochette, Institut national de santé publique du Québec
Michael A. Ruta, Government of Nunavut
Josh Squires, Newfoundland and Labrador Centre for Health Information
Jenny Sutherland, British Columbia Ministry of Health
Hao Wang, Department of Health New Brunswick
This report was made possible through collaboration between PHAC and the respective governments of Alberta, British
Columbia, Manitoba, New Brunswick, Newfoundland and Labrador, Nova Scotia, Northwest Territories, Nunavut, Ontario,
Prince Edward Island, Quebec, Saskatchewan and Yukon. The opinions, results, and conclusions in this report are those of
the authors. No endorsement by the above provinces and territories is intended or should be inferred.
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Endnotes
i Counts and crude prevalence and incidence estimates by sex, age group, year, and province/territory can be accessed online
through the Public Health Infobase: https://health-infobase.canada.ca/
ii Individuals aged 20 years and older with a hospital admission including a diagnostic code of AMI or recorded history of AMI were
included. More details are available in Appendix B, Table 1.
Date modified:
2019-12-09

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Report from the Canadian Chronic Disease Surveillance System:

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Organization: Public Health Agency of Canada

Published: May 2018

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Public Health Agency of Canada

This publication can be made available in alternative formats upon request.

Publication date: May 2018

Purpose of this report

1.2 Defining heart disease

1.3 Stages in the development of heart disease

Figure A. Events leading to heart disease progression

Figure adapted from Jessup M. et al 7 and Dzau VJ et al. 8

Figure A. Events leading to heart disease progression - Text Description

1.4 Purpose of this report

† Age-standardized to the 2011 Canadian population.

* Data from Yukon were not available.

Figure 1A. Text description follows.

2009- 8.3% 8.3-8.3 1.9% 1.9-1.9 2,234,980 510,430

† Age-standardized to the 2011 Canadian population.

* Data from Yukon were not available.

† Age-standardized to the 2011 Canadian population.

* Data from Yukon were not available.

Figure 1B. Text description follows.

† Age-standardized to the 2011 Canadian population.

* Data from Yukon were not available.

2011-2012 3.5% 3.4-3.5 655,760

† Age-standardized to the 2011 Canadian population.

* Data from Yukon were not available.

2.1.2 Incidence (new cases)

† Age-standardized to the 2011 Canadian population.

* Data from Yukon were not available.

Figure 2A. Text description follows.

† Age-standardized to the 2011 Canadian population.

* Data from Yukon were not available.

† Age-standardized to the 2011 Canadian population.

* Data from Yukon were not available.

† Age-standardized to the 2011 Canadian population.

* Data from Yukon were not available.

* Data from Yukon were not available.

Figure 2B. Text description follows.

2001-2002 7.7 per 1,000 people 7.6-7.7 99,070

2003-2004 6.9 per 1,000 people 6.8-6.9 93,320

2005-2006 6.3 per 1,000 people 6.2-6.3 90,170

2007-2008 5.8 per 1,000 people 5.8-5.9 88,710

2009-2010 5.7 per 1,000 people 5.7-5.7 91,570

2010-2011 5.5 per 1,000 people 5.5-5.5 90,940

2012-2013 5.3 per 1,000 people 5.2-5.3 92,850

† Age-standardized to the 2011 Canadian population.

* Data from Yukon were not available.

2.1.3 All-Cause Mortality Rates

† Age-standardized to the 2011 Canadian population.

* Data from Yukon were not available.

Figure 3A. Text description follows.

† Age-standardized to the 2011 Canadian population.

* Data from Yukon were not available.

† Age-standardized to the 2011 Canadian population.

* Data from Yukon were not available.

* Data from Yukon were not available.

Figure 3B. Text description follows.