Twenty-Five Years of Angina–Related Mortality in Elderly Adults Aged ≥ 65 Years: A Retrospective Cohort Study Using Real-World Data from the USA
PDF

Keywords

Angina
Trends
Mortality
Ischemic heart disease (IHD)
Cardiovascular

Categories

Date

How to Cite

1.
Hemida MF, Ibrahim AA, Goel A, et al. Twenty-Five Years of Angina–Related Mortality in Elderly Adults Aged ≥ 65 Years: A Retrospective Cohort Study Using Real-World Data from the USA. ASIDE Int Med. 2025;2(3):24-33. doi:10.71079/ASIDE.IM.110925248

Abstract

Introduction: Angina is one of the ischemic heart diseases (IHD) that contributes to major cardiovascular complications. We aim in this study to assess angina-related mortality among elderly adults aged ≥ 65 years.

Methods: Nationwide mortality records were obtained from the CDC-WONDER database from 1999 to 2023 among U.S. elderly adults aged ≥ 65 with angina. Age-adjusted mortality rates (AAMRs) were calculated per 100,000 population. Joinpoint regression analysis was utilized to evaluate average annual percent changes (AAPCs).

Results: From 1999 to 2023, a total of 36,544 deaths occurred among the elderly with angina in the U.S. The overall AAMR per 100,000 decreased from 7.52 in 1999 to 3.73 in 2023 (AAPC of -3.18; 95%CI: -3.79 to -2.75;

PDF

References

1. Joshi PH, de Lemos JA. Diagnosis and Management of Stable Angina: A Review. JAMA. 2021: 1765 [PMID: 33944871, https://doi.org/10.1001/jama.2021.1527]

2. Kloner RA, Chaitman B. Angina and Its Management. J Cardiovasc Pharmacol Ther. 2017: 199 [PMID: 28196437, https://doi.org/10.1177/1074248416679733]

3. Agho AV, Disu F, Figueroa AS, Wiredu B, Okorigba EM, Olanite M, Okobi OE, Noman T. Prevalence of Angina Pectoris: An Analysis of the National Health Interview Survey (NHIS) Database. Cureus. 2025: e83076 [PMID: 40438860, https://doi.org/10.7759/cureus.83076]

4. Blumenthal DM, Howard SE, Searl Como J, O'Keefe SM, Atlas SJ, Horn DM, Wagle NW, Wasfy JH, Yeh RW, Metlay JP. Prevalence of Angina Among Primary Care Patients With Coronary Artery Disease. JAMA Netw Open. 2021: e2112800 [PMID: 34097047, https://doi.org/10.1001/jamanetworkopen.2021.12800]

5. Arnold SV, Grodzinsky A, Gosch KL, Kosiborod M, Jones PG, Breeding T, Towheed A, Beltrame J, Alexander KP, Spertus JA. Predictors of Physician Under-Recognition of Angina in Outpatients With Stable Coronary Artery Disease. Circ Cardiovasc Qual Outcomes. 2016: 554 [PMID: 27531922, https://doi.org/10.1161/CIRCOUTCOMES.116.002781]

6. Mehta PK, Huang J, Levit RD, Malas W, Waheed N, Bairey Merz CN. Ischemia and no obstructive coronary arteries (INOCA): A narrative review. Atherosclerosis. 2022: 8 [PMID: 36423427, https://doi.org/10.1016/j.atherosclerosis.2022.11.009]

7. Reynolds HR, Bairey Merz CN, Berry C, Samuel R, Saw J, Smilowitz NR, de Souza A, Sykes R, Taqueti VR, Wei J. Coronary Arterial Function and Disease in Women With No Obstructive Coronary Arteries. Circ Res. 2022: 529 [PMID: 35175840, https://doi.org/10.1161/CIRCRESAHA.121.319892]

8. Nanna MG, Wang SY, Damluji AA. Management of Stable Angina in the Older Adult Population. Circ Cardiovasc Interv. 2023: e012438 [PMID: 36916288, https://doi.org/10.1161/CIRCINTERVENTIONS.122.012438]

9. Woodruff RC, Tong X, Khan SS, Shah NS, Jackson SL, Loustalot F, Vaughan AS. Trends in Cardiovascular Disease Mortality Rates and Excess Deaths, 2010-2022. Am J Prev Med. 2024: 582 [PMID: 37972797, https://doi.org/10.1016/j.amepre.2023.11.009]

10. Virani SS, Alonso A, Aparicio HJ, Benjamin EJ, Bittencourt MS, Callaway CW, Carson AP, Chamberlain AM, Cheng S, Delling FN, Elkind MSV, Evenson KR, Ferguson JF, Gupta DK, Khan SS, Kissela BM, Knutson KL, Lee CD, Lewis TT, Liu J, Loop MS, Lutsey PL, Ma J, Mackey J, Martin SS, Matchar DB, Mussolino ME, Navaneethan SD, Perak AM, Roth GA, Samad Z, Satou GM, Schroeder EB, Shah SH, Shay CM, Stokes A, VanWagner LB, Wang NY, Tsao CW, American Heart Association Council on E, Prevention Statistics C, Stroke Statistics S. Heart Disease and Stroke Statistics-2021 Update: A Report From the American Heart Association. Circulation. 2021: e254 [PMID: 33501848, https://doi.org/10.1161/CIR.0000000000000950]

11. Wadhera RK, Shen C, Gondi S, Chen S, Kazi DS, Yeh RW. Cardiovascular Deaths During the COVID-19 Pandemic in the United States. J Am Coll Cardiol. 2021: 159 [PMID: 33446309, https://doi.org/10.1016/j.jacc.2020.10.055]

12. Latif F, Nasir MM, Rehman WU, Hamza M, Mattumpuram J, Meer KK, Silvet H, Yarkoni A, Sabouni MA, Braiteh N, Patel K, Nashwan AJ. Demographics and regional trends of ischemic heart disease-related mortality in older adults in the United States, 1999-2020. PLoS One. 2025: e0318073 [PMID: 39854527, https://doi.org/10.1371/journal.pone.0318073]

13. Maniya MT, Siddiqi AK, Shahzad M, Ali KM, Chachar MA, Amin SB, Garcia M, Naeem M. Rising atherosclerotic cardiovascular disease-related mortality among older adults in the United States: A 22-year retrospective cohort study using the CDC WONDER database. Hellenic J Cardiol. 2025: [PMID: 40701437, https://doi.org/10.1016/j.hjc.2025.06.001]

14. von Elm E, Altman DG, Egger M, Pocock SJ, Gotzsche PC, Vandenbroucke JP, Initiative S. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. J Clin Epidemiol. 2008: 344 [PMID: 18313558, https://doi.org/10.1016/j.jclinepi.2007.11.008]

15. Aggarwal R, Chiu N, Loccoh EC, Kazi DS, Yeh RW, Wadhera RK. Rural-Urban Disparities: Diabetes, Hypertension, Heart Disease, and Stroke Mortality Among Black and White Adults, 1999-2018. J Am Coll Cardiol. 2021: 1480 [PMID: 33736831, https://doi.org/10.1016/j.jacc.2021.01.032]

16. Ingram DD, Franco SJ. 2013 NCHS Urban-Rural Classification Scheme for Counties. Vital Health Stat 2. 2014: 1 [PMID: 24776070,

17. Anderson RN, Rosenberg HM. Age standardization of death rates: implementation of the year 2000 standard. Natl Vital Stat Rep. 1998: 1 [PMID: 9796247,

18. Hemida MF, Khan A, Ibrahim AA, Goel A, Patel K, Shahriar Z, Hageen AW, Alsaadi M, Rahman SU, Arafa A, Kholeif Z, Bahnasy A. Trends in Mortality from Leukemia and Ischemic Heart Disease: A 22-Year Analysis in the U.S. (1999-2020). ASIDE Internal Medicine. 2025: 21 https://doi.org/10.71079/aside.Im.091425163]

19. Ibrahim AA, Hemida MF, Hussein M, Saghir M, Faisal MR, Kritika FNU, Patel K, Ali A, Saghir E, Tablawy M, Mohamed AH, Arafa A. Disparities and Trends in Polycythemia Vera–Related Mortality in U.S. Adults Aged ≥45 Years from 1999 to 2023. ASIDE Internal Medicine. 2025: 24 https://doi.org/10.71079/aside.Im.092725233]

20. Sr P. Joinpoint Regression Program. Joinpoint Trend Analysis Software [Internet]. 2025.

21. Braunwald E. Cardiology: A Century of Progress. Circulation. 2024: 78 [PMID: 38190446, https://doi.org/10.1161/CIRCULATIONAHA.123.064458]

22. Prasad A. Ischemic Heart Disease. 2010 [cited 10/25/2025]. In: Mayo Clinic Internal Medicine Board Review [Internet]: Oxford University Press, [cited 10/25/2025]; [0]. Available from: https://doi.org/10.1093/med/9780199755691.003.0045.

23. Centers for Disease C, Prevention. Heart disease prevalence - health, United States.

24. Liu M, Aggarwal R, Zheng Z, Yeh RW, Kazi DS, Joynt Maddox KE, Wadhera RK. Cardiovascular Health of Middle-Aged U.S. Adults by Income Level, 1999 to March 2020 : A Serial Cross-Sectional Study. Ann Intern Med. 2023: 1595 [PMID: 37983825, https://doi.org/10.7326/M23-2109]

25. Wall HK, Ritchey MD, Gillespie C, Omura JD, Jamal A, George MG. Vital Signs: Prevalence of Key Cardiovascular Disease Risk Factors for Million Hearts 2022 - United States, 2011-2016. MMWR Morb Mortal Wkly Rep. 2018: 983 [PMID: 30188885, https://doi.org/10.15585/mmwr.mm6735a4]

26. Hausvater A, Anthopolos R, Seltzer A, Spruill T, Peteiro J, Lopez-sendon J, Celutkiene J, Sidhu M, Demchenko E, Beleslin B, Kedev S, Grodzinsky A, Spertus J, Fleg J, Maron D, Hochman J, Reynolds H. Abstract 4147235: Sex Differences in Psychosocial Factors and Angina in Patients with Chronic Coronary Disease. Circulation. 2024: https://doi.org/10.1161/circ.150.suppl_1.4147235]

27. Wenger N. Women and Coronary Heart Disease: A Century after Herrick; Understudied, Underdiagnosed, and Undertreated. Circulation. 2011: https://doi.org/10.1161/circ.124.suppl_21.A612]

28. Wenger N. Tailoring cardiovascular risk assessment and prevention for women: One size does not fit all. Glob Cardiol Sci Pract. 2017: e201701 [PMID: 28971101, https://doi.org/10.21542/gcsp.2017.1]

29. Mehta LS, Beckie TM, DeVon HA, Grines CL, Krumholz HM, Johnson MN, Lindley KJ, Vaccarino V, Wang TY, Watson KE, Wenger NK, American Heart Association Cardiovascular Disease in W, Special Populations Committee of the Council on Clinical Cardiology CoE, Prevention CoC, Stroke N, Council on Quality of C, Outcomes R. Acute Myocardial Infarction in Women: A Scientific Statement From the American Heart Association. Circulation. 2016: 916 [PMID: 26811316, https://doi.org/10.1161/CIR.0000000000000351]

30. He J, Bundy JD, Geng S, Tian L, He H, Li X, Ferdinand KC, Anderson AH, Dorans KS, Vasan RS, Mills KT, Chen J. Social, Behavioral, and Metabolic Risk Factors and Racial Disparities in Cardiovascular Disease Mortality in U.S. Adults : An Observational Study. Ann Intern Med. 2023: 1200 [PMID: 37579311, https://doi.org/10.7326/M23-0507]

31. Coronado F, Melvin SC, Bell RA, Zhao G. Global Responses to Prevent, Manage, and Control Cardiovascular Diseases. Prev Chronic Dis. 2022: E84 [PMID: 36480801, https://doi.org/10.5888/pcd19.220347]

32. Kyalwazi AN, Loccoh EC, Brewer LC, Ofili EO, Xu J, Song Y, Joynt Maddox KE, Yeh RW, Wadhera RK. Disparities in Cardiovascular Mortality Between Black and White Adults in the United States, 1999 to 2019. Circulation. 2022: 211 [PMID: 35861764, https://doi.org/10.1161/CIRCULATIONAHA.122.060199]

33. Obi K, Effron MB. Racial Disparities and Excess Cardiovascular Mortality Before and During the COVID-19 Pandemic: Time for a Solution. Mayo Clin Proc. 2022: 2180 [PMID: 36464458, https://doi.org/10.1016/j.mayocp.2022.10.015]

34. Janus SE, Makhlouf M, Chahine N, Motairek I, Al-Kindi SG. Examining Disparities and Excess Cardiovascular Mortality Before and During the COVID-19 Pandemic. Mayo Clin Proc. 2022: 2206 [PMID: 36336516, https://doi.org/10.1016/j.mayocp.2022.07.008]

35. Sekkarie A, Woodruff RC, Casper M, Paul AT, Vaughan AS. Rural-urban disparities in cardiovascular disease mortality vary by poverty level and region. J Rural Health. 2025: e12874 [PMID: 39152622, https://doi.org/10.1111/jrh.12874]

36. Kulshreshtha A, Goyal A, Dabhadkar K, Veledar E, Vaccarino V. Urban-rural differences in coronary heart disease mortality in the United States: 1999-2009. Public Health Rep. 2014: 19 [PMID: 24381356, https://doi.org/10.1177/003335491412900105]

37. Ritchey MD, Wall HK, Owens PL, Wright JS. Vital Signs: State-Level Variation in Nonfatal and Fatal Cardiovascular Events Targeted for Prevention by Million Hearts 2022. MMWR Morb Mortal Wkly Rep. 2018: 974 [PMID: 30188881, https://doi.org/10.15585/mmwr.mm6735a3]

38. Bairey Merz CN, Pepine CJ, Walsh MN, Fleg JL. Ischemia and No Obstructive Coronary Artery Disease (INOCA): Developing Evidence-Based Therapies and Research Agenda for the Next Decade. Circulation. 2017: 1075 [PMID: 28289007, https://doi.org/10.1161/CIRCULATIONAHA.116.024534]

39. Faheem MSB, Fatima Y, Munir SU, Khabir M, Khatri N. Trends in ischemic heart disease and thromboembolism-related mortality in the United States, 1999-2024: A population-based analysis using CDC WONDER Data. Thromb Res. 2025: 109482 [PMID: 40987074, https://doi.org/10.1016/j.thromres.2025.109482]

40. McLeod K, Thielen S, Mosley B, Sevick C, Khazanie P. Resource Utilization For Medicare Beneficiaries With Heart Failure At The End Of Life. Journal of Cardiac Failure. 2024: https://doi.org/10.1016/j.cardfail.2023.10.446]

41. Chuzi S, Molsberry R, Ogunseitan A, Warraich HJ, Wilcox JE, Grady KL, Yancy CW, Khan SS. Trends in Place of Death for Cardiovascular Mortality Related to Heart Failure in the United States From 2003 to 2017. Circ Heart Fail. 2020: e006587 [PMID: 32059627, https://doi.org/10.1161/CIRCHEARTFAILURE.119.006587]

42. Warraich H, Kaufman BG, Cross SH. Trends and Factors Associated with Place of Death among Individuals with Cardiovascular Disease in the United States. Innovation in Aging. 2019: S132 https://doi.org/10.1093/geroni/igz038.482]

43. Merriel SWD. Management of angina in primary care. Nurse Prescribing. 2017: 492 https://doi.org/10.12968/npre.2017.15.10.492]

44. Banerjee A. Stable coronary disease: Cinderella must go to the ball. Eur Heart J Qual Care Clin Outcomes. 2016: 151 [PMID: 29474614, https://doi.org/10.1093/ehjqcco/qcw022]

45. Leucker TM, Schulman SP, Gerstenblith G. Stable ischemic heart disease: how to keep it that way. J Clin Invest. 2020: 1055 [PMID: 31985489, https://doi.org/10.1172/JCI135959]

46. Ahmed M, Javaid H, Shafiq A, Nadeem ZA, Ahsan A, Nofal A, Ahmed R, Alam M, Fudim M, Fonarow GC, Mamas MA. Trends and Disparities in Coronary Artery Disease and Obesity-Related Mortality in the United States From 1999-2022. Endocrinol Diabetes Metab. 2024: e70010 [PMID: 39462250, https://doi.org/10.1002/edm2.70010]

47. Guan C, Wu S, Xu W, Zhang J. Global, regional, and national burden of ischaemic heart disease and its trends, 1990-2019. Public Health. 2023: 57 [PMID: 37604031, https://doi.org/10.1016/j.puhe.2023.07.010]

48. Marchionni N, Orso F. Stable angina in the elderly: diagnostic and therapeutic approach. J Cardiovasc Med (Hagerstown). 2018: e84 [PMID: 29538150, https://doi.org/10.2459/JCM.0000000000000603]

49. Paquin A, Bastiany A, Piche ME. The Complexity of Racial and Ethnic Disparities in Cardiovascular Health: A Role for Underrepresented Populations-Focused Clinics? Can J Cardiol. 2023: 1667 [PMID: 37897474, https://doi.org/10.1016/j.cjca.2023.09.016]

50. Wenger NK. The Feminine Face of Heart Disease 2024. Circulation. 2024: 489 [PMID: 38346107, https://doi.org/10.1161/CIRCULATIONAHA.123.064460]

51. Sanchez JM, Marcus GM. American Indians and atrial fibrillation. Heart Rhythm O2. 2022: 760 [PMID: 36588996, https://doi.org/10.1016/j.hroo.2022.08.010]

52. Kershaw KN, Khan SS. Moving Beyond the Individual: Multilevel Solutions for Equitable Hypertension Control. Circ Cardiovasc Qual Outcomes. 2022: e009374 [PMID: 36065816, https://doi.org/10.1161/CIRCOUTCOMES.122.009374]

Creative Commons License

This work is licensed under a Creative Commons Attribution 4.0 International License.

Copyright (c) 2025 Mohamed Fawzi Hemida, Alyaa Ahmed Ibrahim, Anika Goel, Mirna Hussein, Krish Patel, Muhammad Raza Sarfraz, Omar Y. Alkasabrah, MD, Maryam Saghir, Komal Karmani, Eshal Saghir, Zahin Shahriar, Safeya Fawzi, Ahmed Bahnasy, Muhammad Faizan Ali, Amro Ali, Ahmad M. Abdelkhalek, Raheel Ahmed, MBBS, MRCP, PhD