Heart disease – the facts

In all my life, I have personally known one person who has died from heart disease (a hereditary heart condition). I worked as an HR Director for 12 years for large corporations and I can’t remember having to deal with a death from heart disease in that time.

Heart charities and researchers love to position the stats as “one in three people dies from heart disease.” It makes them seem more important and needed and should lead to increased funding.

But doesn’t it make you wonder why you haven’t lost a third of your friends and family?

Fact 1 – death rates are tiny

There were 270,804 male deaths and 288,813 female deaths from all causes, for people under the age of 65, in the UK in 2009.[i] Table 1.1 in the European statistics document further tells us that 17% of the deaths in men were from coronary heart disease (CHD) and 32% from cardiovascular disease (CVD). The data for women shows that 12% of the deaths were from CHD and 32% from CVD. (CHD includes angina and heart attacks. CVD includes all diseases of the circulation including CHD, cardiomyopathy and stroke.)

32% is where the “one third” comes from. One third from cardiovascular disease, not the narrower term heart disease, is the first thing to note. However, this is a trivial point in comparison to the significant one…

The number of deaths, without knowing ‘out of how many’, is pretty meaningless. So, table 1.4 in the same Euro document, is the most useful one. This gives death rates for CHD for people under the age of 65. These are usually presented in terms of “deaths per 100,000” i.e. for every 100,000 UK people – how many died from coronary heart disease?

The figures are 33 for men in 2009 and 8 for women. Yes – 33 in every 100,000 men died from coronary heart disease in 2009 and 8 in every 100,000 women died from CHD in 2009. How small is that?!

You would have needed to know 3,030 men (under the age of 65) for 1 of them to have been likely to die from heart disease during 2009. You would have needed to know 12,500 women (under the age of 65) for 1 of them to have been likely to die from heart disease during 2009.

How different is that to the headlines “one in three die from heart disease”?

That’s why I personally know one person who has died from heart disease.

Fact 2 – being male has a significant impact, but death rates are still tiny

You can see from the UK figures that we could claim that four times as many men as women die from heart disease (33 in 100,000 vs. 8 in every 100,000). And indeed heart disease is weighted against men and in favour of women (while women have higher cholesterol ha ha). However, this is also misleading.  The reality is that you’d still need 3,030 male friends and 12,500 female friends just to be likely to lose 1 of them. Being a UK woman under 65, I’ve got the 1 in 12,500 stats on my side and I wouldn’t lose any sleep over my numbers or 1 in 3,030.

Fact 3 – age is the massive and unavoidable factor

The US death rate from all causes for 2006 was 0.78%.[ii] Don’t compare these figures directly with the UK deaths because these US deaths include everyone of all ages (not just under 65s). The third key fact about heart disease is that it is massively dependent on age…

The US death rate from all causes of 0.78% means that 777 people, per 100,000 residents of the population, died in 2006. Death certificates recorded 200 of these deaths as being from heart disease.[iii] So 0.2% of the USA population died from heart disease in 2006. That means, if you had 500 friends of any age, you were likely to lose 1 of them to heart disease during 2006.

However – the single most important factor is the age of your friends. You would need to have known 166,667 children aged 5-14 to have a likelihood of 1 dying from heart disease and yet you only needed to know 22 people aged 85 and over, for 1 of them to have been likely to have heart disease on their death certificate during 2006.

So the next time someone tells me that I have a 1 in 3 chance of dying from heart disease I’ll tell them “I’ve got a 1 in 12,500 chance of that happening in any year before I’m 65.”



[i] Table 1.1 from the full 2012 report available here: http://www.ehnheart.org/cvd-statistics.html

[ii] Centres for Disease Control and Prevention, (Using age adjusted data), http://www.cdc.gov/nchs/hus/contents2010.htm (Table 29).

[iii] http://www.cdc.gov/nchs/hus/contents2010.htm (Table 30).


p.s. can you do anything about heart disease?

The three main factors in heart disease you can do nothing about:

1) genetics;
2) sex;
3) age.

If you’re male and your brother(s), father, father’s father and father’s brother(s) died young (under 65) from heart disease, you’d better hope that you inherited your mother’s genes and that they were better than the male side of your family. Or get your bucket list done early. If you were born male, too bad, but don’t lose sleep over 35 in 100,000 – stress is very bad for your heart. As for aging, as George Burns allegedly quipped “aging is better than the alternative”!

Genetics aside, you may be able to improve your odds, against the 35 in 100,000 average, by not smoking, not eating processed food, managing stress, having purpose in life and being naturally active (walking the dog, not marathon running). Table 1.4 [i] tells us that France had the lowest male death rate from CHD in Europe. French men had a rate of 15 deaths per 100,000 people (data for 2008) – twice that of British women (i.e. being French couldn’t trump being female) and half that of British men, if you like those nonsense relative numbers.

Living in France has got to be pretty marvelous – the odd lorry blockade, but no war; red wine and red steak; quality cheese and chocolate; skiing and sand dunes; work life balance and family units. However, even if you move there, and hope that the French advantage is nurture, not nature, you’d need to know 6,600 French men under 65 to lose 1 from heart disease vs. 3,030 men in the UK. Neither is worth worrying about. Your biggest risk comes with every year beyond 65 no matter which country you’re in.

Posted in Media comments, Research
Tags: , , , , , , , , ,
15 comments on “Heart disease – the facts
  1. avatar William Aspden says:

    Apart from family I only know 1 person that died (well) after a heart attack. He never smoked or drank and told me his doctor said it would have been much worse if he did.
    My mother died from a brain bleed at age 90, with no previous events. My father had a series of heart attacks at 90 and died at 95 of other things, mostly I think it was that my mother was no longer here. I am off to have a hearty breakfast of bacon and (home grown, free yard) eggs.

  2. avatar Robin Dowswell says:

    Hi Catherine, Strangely enough I’ve just had a heart attack. Arteries completely clear, cause unknown. As I’m a high standard endurance athlete it’s been pointed out to me that there is evidence that endurance athletes are far more prone to ventral fibrillation than the general population. I’ve had a defibrillator device inserted into my chest and no drugs other than a very low dose of beta blocker which I will be questionning with the specialists when I have a check up.
    The point I was making was that the fact that 1/3rd of people are affected by heart disease at some stage in their life whether related to the arteries or the heart organ is surely significant. Not only that, but when you start speaking to people after you’ve had a major incident like myself, you find there are many people affected, even by rare cases of “athletic heart irregularities” like my own.
    I felt that Zoe was in parts of the article implying that heart/vascular disease was no big deal given the numbers. She then used the timeframe of 1 year and age under 65 and restricted the definition to heart rather than vascular disease. All these factors reduce the apparent incidence of the disease, whereas in fact it is a major factor in the lives of a number of people.
    I agree strongly that we don’t want to provide drugs to people who don’t need them, but there is no doubt that many people need to make alterations in their lives that reduce the risk of heart related problems. For most people this begins with diet and exercise. For me maybe not that simple!

  3. avatar Tom says:

    Sorry to hear about your husband Catherine. Suggesting that people with normal cholesterol are not at risk of heart disease is like saying people driving at 30mph are not at risk of crashing their car. I’m sorry that your husband had side-effects, it was still the right thing to prescribe a statin and the right thing to stop it when he got side-effects. It is something people forget to say about statin side-effects, if you get them you can stop the drug and they go away, deaths from currently available statins are extremely rare.

    In terms of information I think high quality medical journals are a much better source of information than books and blogs by people with an intransigent view. For the record my view is completely changeable. For now I think the evidence is strongly in favour of a trial of statins for most patients who have had a heart attack. Prescribing them for primary prevention is another matter, there probably is a tiny benefit but in the grand scheme of things it is a marginal benefit. I will be happy to change my view as more data comes in.


  4. avatar Catherine says:

    Partly in answer to Tom – my husband suffered a heart attack in 2011. Just prior to this, he’d had a blood test, and this included his cholesterol level being taken. It was under 4.0, so not at what the “experts” consider a high level. Yet he still suffered a heart attack. Thankfully, he’s OK, and still doing well. He was automatically prescribed a statin, though, on his discharge from hospital, and I couldn’t help wondering why, when his cholesterol had not been “high” to start with. He became far more ill from taking that Simvastatin than I’d ever seen him before, barely able to climb our stairs because his legs ached so much, barely able to stay awake when he was relaxing in the evenings, and convinced he had dementia because his memory had suddenly become so bad. I surreptitiously checked exactly what drugs he’d been prescribed after his heart attack, and checked them all out regarding side effects, and Simvastatin seemed to me to be the culprit. The list of potential side effects could have been written for him. I showed him what I’d found, and he decided to stop taking the statin immediately. Within a couple of days, he was transformed, and no longer worried that he was headed for the old folks’ home prematurely. His cholesterol level, obviously, is still checked regularly because of his cardiac history, but it remains at around 4.0. I am unsure why Tom and Robin think that Zoe has missed the point regarding deaths from heart disease – I think she pointed out very clearly that the figures that are relentlessly published in the media are skewed, and how this happens. Scaremongering creates big business, and even before I discovered Zoe’s blog and her book, I was convinced that we were all being misled in many different ways. Read Dr Kendrick’s blog and book, too, Tom and Robin – very informative and eye-opening.

  5. avatar Tom says:

    Zoe- it is really hard to take anyone seriously who says ‘cholesterol has got nothing to do with heart disease’ and cherry-picks figures the way you do. Do over 65’s somehow not count? The vast majority of us will live to that age and we will all die of something, that fact that 1/3 of us will die from CVD is at least worthy of note. Personally I suspect that cholesterol is not toxic to arteries at levels below about 8mmol/l (although it probably is toxic in very high levels), and that it is a bystander in the effect of statins (which is real, but incredibly weak with very high NNT’s). Cholesterol is however a risk marker for CVD whether implicated in pathogenesis or not. Whilst some of what you say is undoubtably true you stand so far to one end of the argument that it comes across as conspiracy theory, unable to accept some of the facts that are not in your favour. A shame really as the cause you are fighting for is an extremely important one.

    • avatar Zoë Harcombe says:

      Hi Tom
      Here’s the relationship between cholesterol and heart deaths and all deaths for men and women for the WHO’s 192 countries.
      Best wishes – Zoe

      • avatar MJHopeC says:

        This is why, when looking at the results of a drug trial I reduce the results to a probability of whether one individual will benefit per annum; or conversely the probability of not benefiting.

        For example Collins in a recent statement claimed that if 3 million individuals were treated with statins 10,000 would be “saved” per year. Simple arithmetic (10,000/3,000,000) gives a probability of 0.003 (rounded to 2 decimal places, p = 0.00) or conversely the probability of no benefit p = 0.997 (rounded to 2 decimal places, p = 1.00).

        Frankly these odds do not impress me but to some the “10,000 would be “saved” per year” sounds wonderful. It certainly demonstrates how figures can be used to obfuscate reality

  6. avatar Robin Dowswell says:

    Zoe, I’m rather surprised by your attitude to heart disease.
    The fact remains it is set to kill roughly 1 in 3 people in the UK. Most of those will either lose their life or have it degraded by heart disease before they should have done. The statistics you quote for 1 year I would suggest mislead. I’m not particularly worried about about losing my friends this year, but over the next 2-4 decades I certainly would appreciate their company. The stats mount up and the figure of 33% becomes a lot closer when looked at over a realistic time frame.
    While sex, genetics and age are inevitable why should we feel restricted by them? Surely, the important point is to eat and exercise in a way that reduces the risk of such a serious disease.

  7. avatar Paul Travis says:

    Now there you go again Zoe: what have facts got to do with it? Politicians, Big Pharma and Agribusiness are not going to like you playing with their numbers. Their purpose is to instil fear and dread into each and everyone one of us so that they can ‘save our lives’, although it will not come cheap but hey, we are going to live forever by following government health guidelines, eating vitamin-fortified, low-fat, high carb processed foods and taking life-saving drugs (statins)…aren’t we?? Surely these people know what’s best for us…don’t they?? They can prevent us from dying…can’t they??
    I just might carry on risking death by continuing to eat Real Food, enjoying the small pleasures of life with a daily appreciation of good things (red wine and dark chocolate in particular!), keep active and avoid prescribed medication if I can (although I confess to taking an antihistamine this morning).
    Appreciate your hard work Zoe. We’re right behind you!

  8. avatar Ash Simmonds says:

    “red wine and red steak”–

    Hey that’s my diet!

  9. avatar Mark John says:

    Just a thought, has anyone bothered asking the French WTF they’re doing living so long in the absence of heart disease? Don’t the French have the highest cholesterol levels in Europe? I think big pharma should start telling the French to start dropping like flies of anything heart related!

  10. avatar Michael B says:

    There you go, bothering us with the facts again. How can we be scared into taking statins if we know things like this?

    • avatar Zoë Harcombe says:

      Ha ha Michael – I didn’t think of that! WTF is anyone doing on statins? Not least because cholesterol has nothing to do with heart disease and because statins have nothing to do with genetics/age and sex and because the patient leaflets say not suitable for over 70 year olds and there’s nothing to worry about before then anyway… and…and

      Await Malcolm Kendrick’s next book! More fun with numbers
      Best wishes – Zoe

  11. avatar Tom Welsh says:

    Thanks, Zoe. I reached 65 eight months ago! 8-)

    • avatar Zoë Harcombe says:

      Hi Tom – so here’s the UK age data (top link) http://www.bhf.org.uk/research/heart-statistics/mortality/time-trends.aspx

      So it goes from 165/100,000 for UK men aged 55-64 to 396 for 65-74 year olds. You’re only just into the 65 stats and you can have 252 male friends aged 65-74 to have expected to lose 1 in 2010. I still can’t get troubled by those numbers. I’d even take a 1 in 22 chance over 85. Rather go with a bang at 90 than have cancer any time!

      Best wishes – Zoe

Leave a Reply

Your email address will not be published. Required fields are marked *