Objective To investigate the incidence of cardiovascular disease (CVD) overall and by age, sex, and socioeconomic status, and its variation over time, in the UK during 2000-19. Design Population based study. Setting UK. Participants 1 650 052 individuals registered with a general practice contributing to Clinical Practice Research Datalink and newly diagnosed with at least one CVD from 1 January 2000 to 30 June 2019. Main outcome measures The primary outcome was incident diagnosis of CVD, comprising acute coronary syndrome, aortic aneurysm, aortic stenosis, atrial fibrillation or flutter, chronic ischaemic heart disease, heart failure, peripheral artery disease, second or third degree heart block, stroke (ischaemic, haemorrhagic, and unspecified), and venous thromboembolism (deep vein thrombosis or pulmonary embolism). Disease incidence rates were calculated individually and as a composite outcome of all 10 CVDs combined and were standardised for age and sex using the 2013 European standard population. Negative binomial regression models investigated temporal trends and variation by age, sex, and socioeconomic status. Results The mean age of the population was 70.5 years and 47.6% (n=784 904) were women. The age and sex standardised incidence of all 10 prespecified CVDs declined by 19% during 2000-19 (incidence rate ratio 2017-19 v 2000-02: 0.80, 95% confidence interval 0.73 to 0.88). The incidence of coronary heart disease and stroke decreased by about 30% (incidence rate ratios for acute coronary syndrome, chronic ischaemic heart disease, and stroke were 0.70 (0.69 to 0.70), 0.67 (0.66 to 0.67), and 0.75 (0.67 to 0.83), respectively). In parallel, an increasing number of diagnoses of cardiac arrhythmias, valve disease, and thromboembolic diseases were observed. As a result, the overall incidence of CVDs across the 10 conditions remained relatively stable from the mid-2000s. Age stratified analyses further showed that the observed decline in coronary heart disease incidence was largely restricted to age groups older than 60 years, with little or no improvement in younger age groups. Trends were generally similar between men and women. A socioeconomic gradient was observed for almost every CVD investigated. The gradient did not decrease over time and was most noticeable for peripheral artery disease (incidence rate ratio most deprived v least deprived: 1.98 (1.87 to 2.09)), acute coronary syndrome (1.55 (1.54 to 1.57)), and heart failure (1.50 (1.41 to 1.59)). Conclusions Despite substantial improvements in the prevention of atherosclerotic diseases in the UK, the overall burden of CVDs remained high during 2000-19. For CVDs to decrease further, future prevention strategies might need to consider a broader spectrum of conditions, including arrhythmias, valve diseases, and thromboembolism, and examine the specific needs of younger age groups and socioeconomically deprived populations. Access to Clinical Practice Research Datalink (CPRD) data is subject to a license agreement and protocol approval process that is overseen by CPRD’s research data governance process. A guide to access is provided on the CPRD website () To facilitate the subsequent use and replication of the findings from this study, aggregated data tables are provided with number of events and person years at risk by individual condition and by calendar year, age (by five year age band), sex, socioeconomic status, and region (masking field with fewer than five events, as per CPRD data security and privacy regulations) on our GitHub repository ().

中文翻译：

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20年来英国2200万人心血管疾病发病率趋势：基于人群的研究


目的 调查 2000-19 年英国心血管疾病 (CVD) 的总体发病率以及按年龄、性别和社会经济状况划分的发病率及其随时间的变化。设计基于人群的研究。设置英国。参与者 1 650 052 名在全科诊所注册并为临床实践研究数据链做出贡献的个人，并在 2000 年 1 月 1 日至 2019 年 6 月 30 日期间新诊断出至少一种 CVD。 主要结果指标 主要结果是 CVD 的事件诊断，包括急性冠脉综合征、主动脉瘤、主动脉瓣狭窄、心房颤动或心房扑动、慢性缺血性心脏病、心力衰竭、外周动脉疾病、二度或三度心脏传导阻滞、中风（缺血性、出血性和未明确）和静脉血栓栓塞（深静脉血栓或肺栓塞） ）。疾病发病率是单独计算的，也是所有 10 种 CVD 的综合结果，并使用 2013 年欧洲标准人口对年龄和性别进行标准化。负二项回归模型研究了年龄、性别和社会经济地位的时间趋势和变化。结果 人口平均年龄为 70.5 岁，其中 47.6% (n=784 904) 为女性。 2000-19 年期间，所有 10 种预先指定的 CVD 的年龄和性别标准化发病率下降了 19%（2017-19 年与 2000-02 年的发病率比：0.80，95% 置信区间为 0.73 至 0.88）。冠心病、脑卒中发病率下降约30%（急性冠脉综合征、慢性缺血性心脏病、脑卒中发病率比分别为0.70（0.69～0.70）、0.67（0.66～0.67）、0.75（0.67～0.83） ）， 分别）。与此同时，心律失常、瓣膜疾病和血栓栓塞性疾病的诊断数量也不断增加。 因此，自 2000 年代中期以来，这 10 种疾病的 CVD 总体发病率保持相对稳定。年龄分层分析进一步表明，所观察到的冠心病发病率下降主要限于60岁以上的年龄组，而较年轻的年龄组几乎没有改善或没有改善。男性和女性之间的趋势总体相似。几乎所有调查的CVD都观察到社会经济梯度。梯度并没有随着时间的推移而降低，并且对于外周动脉疾病（最贫困与最不贫困的发病率比：1.98（1.87至​​2.09））、急性冠状动脉综合征（1.55（1.54至1.57））和心力衰竭（1.50）最为明显。 （1.41 至 1.59））。结论 尽管英国在预防动脉粥样硬化疾病方面取得了实质性进展，但 2000-19 年间 CVD 的总体负担仍然很高。为了进一步减少心血管疾病，未来的预防策略可能需要考虑更广泛的疾病，包括心律失常、瓣膜疾病和血栓栓塞，并检查年轻群体和社会经济贫困人群的具体需求。临床实践研究数据链 (CPRD) 数据的访问须遵守许可协议和协议批准流程，并由 CPRD 的研究数据治理流程监督。 CPRD 网站上提供了访问指南 () 为了便于后续使用和复制本研究的结果，提供了汇总数据表，其中包含按个人情况和日历年、年龄划分的事件数量和面临风险的人年（按五年年龄范围划分）、性别、社会经济地位和地区（根据 CPRD 数据安全和隐私法规，屏蔽事件少于 5 个的字段）在我们的 GitHub 存储库 () 上。